Endoscopic view of sinonasal cancer 6 years post-treatment

Ear, Nose & Throat Journal, Nov, 2007 by Dewey A. Christmas, Jr., Joseph P. Mirante, Eiji Yanagisawa

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A 71-year-old man with a history of cancer of the right nasal cavity and ethmoid sinus was followed for 6 years. He had originally presented with right nasal obstruction and nasal bleeding. At the time of the original surgery and biopsy, he was found to have a large, bulky exophytic polypoid mass in the right nasal cavity (figure, A). The pathologic diagnosis at that time was squamous cell carcinoma. Excision of the lesion in the nose and functional endoscopic sinus surgery were carried out, and the patient underwent radiation therapy. He did well except for postoperative nasal crusting.

Six years postoperatively, the patient developed persistent serous otitis media in the left ear. Tympanography showed left eustachian tube dysfunction. During an office visit for evaluation of the eat" disease, a complete examination of the nasal cavities and nasopharynx was also performed. Nasal endoscopy revealed a widely patent right nasal cavity and patent postoperative sinusotomies with scattered crusting but no evidence of recurrent tumor (figure, B) and a narrow left nasal cavity with crusting. Computed tomography (CT) of the sinuses at this 6-year-postoperative visit showed mucosal thickening of the right maxillary sinus and concha bullosa of the right middle turbinate (figure, C). There was also stenosis of the right choana (figure, D). Nasopharyngeal endoscopy showed some crusting but no tumor. The left serous otitis media eventually disappeared after the patient was treated with endoscopic removal of the crusting, nasal irrigation, and antibiotics.

Sinonasal malignancies present a challenge to the otolaryngologist. They are often associated with a poor prognosis, partly because of their insidious onset and proximity to the vital areas of the brain and orbit. (1,2) Even in cases of successful treatment, the patient's quality of life is generally less than optimal.

The early signs and symptoms of sinonasal malignancies can be difficult to distinguish from those of benign disease. We cannot overemphasize the importance of obtaining a biopsy of sinonasal tissue at the time of endoscopic sinonasal surgery. A high index of suspicion is necessary when treating nasal tumors. In the long term, aggressive care of the nasal cavity with debridement and irrigation may be necessary to maintain basic nasal function.

References

(1.) Batsakis JG, Sciubba JJ. Pathology. In: Blizter A. Lawson W, Friedman WH, eds. Surgery of the Paranasal Sinuses. 2nd ed. Philadelphia: W.B. Saunders: 1991:131-7.

(2.) Poetker DM, Toohill RJ, Loehrl TA, Smith TL. Endoscopic management of sinonasal tumors: A preliminary report. Am J Rhinol 2005:19(3):307-15.

Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante), and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group: the Section of Otolaryngology, Hospital of St. Raphael: and the Section of Otolaryngology. Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).