Advanced sinonasal malignancy – therapeutic challenge

Abstract

Maxillofacial tumors are rare malignancies that constitute about 0.2-0.5% of all human malignancies. The initial symptoms of the disease are non-typical and imitate inflammation of paranasal sinuses. Most often, patients report one-sided nasal obstruction with bloody and purulent discharge and headaches. In addition to physical examination - often with the use of endoscopic nasal cavity assessment, it is necessary to perform computed tomography of the paranasal sinuses and magnetic resonance for accurate assessment of the extent of the lesions. Histopathological examination of tumor specimens is necessary for making the final diagnosis and planning treatment. Squamous cell carcinoma is the most common histological type in the sinonasal region. Other common malignancies in this area include adenocarcinoma, carcinoma adenoides cysticum, lymphomas, melanoma, and olfactory neuroblastoma. The treatment of choice of all malignant changes in the sinonasal complex, except for lymphomas, is surgical treatment. Unfortunately, a still high percentage of lesions is diagnosed at an advanced stage of the disease, when the infiltration includes the skull base. In these cases, the decision to perform a radical surgical treatment in the patient is very difficult and requires a lot of experience in the surgery of the skull base. However, due to the low radiosensitivity and low effectiveness of chemotherapy in sinonasal malignancy, resection of lesions and complementary treatment contribute to the prolongation of overall survival in this group of patients. The article discusses the cases of two patients with advanced cancer of the sinonasal complex reffered to the Otolaryngology Department of the Medical University of Warsaw.