A Case of Nasal Septum Cancer Treated by a Combination of the Midfacial Degloving and Rhinoplasty using an Iliac Graft

Abstract

Malignant tumor originating from the nasal septum accounts for a relatively small number of cases of head and neck cancer. In the early stages, as in cases of other head and neck squamous cancer, resection of the tumor by nasal surgery is the treatment of choice, although some cases with early carcinoma of the nasal septum have been treated by endoscopic surgery. We encountered a case of nasal septum cancer, in which we conducted nasal surgery and reconstructed the nasal bone using a graft from the ilium. The patient was a 63-year-old man who visited our hospital with the chief compliant of recurrent nosebleeds. Examination revealed a tumor of the nasal septum in the left nasal cavity. Contrast-enhanced CT and MRI revealed a mass measuring about 30 mm in diameter showing heterogeneous contrast enhancement. The lesion was found to have invaded the nasal septum cartilage. However, there was no spread to the mucosa lining on the opposite side of the nasal septum. The head side of the lesion was very close to the nasal bone. Therefore, we could not rule out invasion of the nasal bone. On biopsy, the lesion was diagnosed as a squamous cell carcinoma. There was no swelling of the cervical lymph nodes. PET-CT revealed accumulation only in the nasal cavity. There was no evidence of cervical lymph node metastasis or distant metastasis. We scheduled surgery under the diagnosis of nasal cavity cancer, cT2N0M0. By using a nasal endoscope, it was disconnected nostril side and the nasal cavity the bottom side of the tumor. The nasal cavity was accesed by the midfacial degloving method. We excised a part of the nasal bone, the outer nose cartilage and a part of the nasal septal mucousa with a sufficient safety margin. We reconstructed the nasal bone and the outer nose cartilage with a graft obtained from the ilium. The patient has shown no evidence of postoperative recurrence. We selected surgical therapy without radiation therapy/chemotherapy. As a result, we were able to avoid disabling systemic chemotherapy and radiation, and reserve these treatments for any recurrences.