Surgical Management of Sinonasal Cancer

Abstract

Sinonasal cancers account for less than 1% of all malignancies and comprise 3% of all head and neck malignancies. The most common malignant neoplasm in the sinuses and nose is squamous cell carcinoma, which accounts for 70% of these neoplasms. Most of these arise in the maxillary antrum, and only 10% to 30% occur in the nasal cavity or ethmoid sinus. It is well known the surgery is primary treatment for sinonasal malignancies. Adjunctive irradiation and/or chemoradiatioin has resulted in improved locoregional control and increased survival rates. The goal of surgical resection is to remove the cancer en bloc, with clear margin devoid of neoplastic cells. For maxillary sinus neoplasms, maxillectomy is a standard surgical procedure. Neoplasms involving the ethmoid, frontal, or sphenoid sinuses may require a craniofacial approach because of frequent invasion into the skull base. The proximity of the nasal cavity and paranasal sinuses to the adjacent structures including the orbit, dura, brain, cranial nerves, and carotid arteries mandates careful radiologic and neurologic evaluations throughout the course of the disease. Surgical advances now permit complex tumor removal and reconstruction surrounding these structures resulting in functional and cosmetic improvements when compared to earlier techniques.