Endoscopic Management of Malignant Sinonasal Tumours

Abstract

The nasal cavity and paranasal sinuses are in close anatomical proximity to many essential structures and also offer conditions in which tumours can grow for substantial periods of time before tumour growth becomes restricted. Hence, sinonasal malignancies can attain a significant size prior to the patient presenting, necessitating an aggressive approach in treating tumours growing near to the base of the skull, the orbital cavities, the cranial nerves and major blood vessels. Whilst sinonasal malignancies (SNM) are seldom seen, when they do occur, they are of grave concern. Typically, the patient remains asymptomatic at an early stage of tumour growth, a situation compounded by the tumour mimicking the symptoms of other frequently encountered, but less grave conditions (such as a nosebleed on one side or a blocked nose). When such mimicry occurs, both the patient and doctor may frequently discount, or fail adequately to account for the seriousness of the underlying pathology, erroneously treating the neoplasia as a benign, non-neoplastic disorder. Once signs or symptoms more easily associated with malignancy appear (e.g. a headache that is both very marked and fails to respond to treatment, disturbed vision or cranial nerve signs), the tumour may already be advanced. Anatomical considerations are responsible for the late presentation of malignant sinonasal tumours and the difficulty in treating them. Tumours arise in areas abutting vital anatomical structures such as the base of the skull, the orbits, the path of cranial nerves and major blood vessels. Surgical removal of these neoplasms results in evident morbidity and marked complications. Effective treatment calls for multidisciplinary team working, ideally with representation from the following specialties: surgical oncology (head and neck), reconstructive surgery, maxillofacial prosthodontics, radiotherapy, medical oncology, neuroradiology, histopathology and neurosurgery and the patient him- or herself.