The nasal cavity and sinuses are hidden and adjacent to important structures (orbit, skull base, etc.), so local malignant tumors are difficult to be detected in early stage, and once the symptoms appear, they are mostly in the middle and late stage.
Etiology: 1. Long-term stimulation of chronic rhinitis and sinusitis can transform the mucous membrane of nasal cavity and become the basis for the occurrence of squamous carcinoma.
2. High incidence of exposure to wood dust workers and nickel workers.
3.Malignant transformation of benign tumor: such as nasal polyp, inversion papilloma repeatedly recurring, multiple surgeries, with the possibility of malignant transformation.
Symptoms and diagnosis: The nasal cavity is slightly conical, divided into left and right sides, and the sinuses are located around the nasal cavity with 4 groups: frontal sinus, sieve sinus, maxillary sinus, and pterygoid sinus, located deep in. The periphery is adjacent to the orbit, skull and pharyngeal cavity. Early symptoms include blood in the nose and nasal congestion. In the late stage, tumor invading the peripheral structures can cause headache, vision loss, diplopia, toothache, difficulty in opening mouth, facial swelling, and even nasal hemorrhage. Physical examination can reveal nasal masses. Pathological biopsy can confirm the diagnosis. Imaging examinations (CT, MRI, etc.) can help to understand the scope of the tumor, the involved organs, and help clinical staging. For patients over 40 years old with persistent nasal blood, if no mass is found on examination, a CT examination of sinus should also be done to avoid missing the diagnosis, and sometimes even surgical biopsy is needed to clarify the diagnosis.
Treatment: Since most of the tumors are already in the middle and late stages when they are found, the treatment should be comprehensive, radiotherapy + surgery or chemotherapy + surgery + radiotherapy. Generally speaking, radiotherapy is adopted first before surgery. Radiation therapy kills the tumor first, so that the tumor can be reduced in scope, which makes the complete removal of the tumor possible and preserves the function of surrounding organs to the maximum extent. If the tumor invades the skull base (sieve roof, dura mater, intracranial, etc.), then a combined craniofacial approach should be adopted. The surgery may cause facial scars, but with the surgeon’s design, the scars can be minimized. For example, we will adopt mid-facial flip incision, double coronal incision, brow arch incision, etc. The surgery will be performed from a hidden location according to the tumor site, which can remove the tumor and avoid facial scars at the same time. The surgery may also require the removal of adjacent organs invaded by the tumor (such as orbital content, maxilla, etc.), the former of which is reduced by preoperative radiotherapy; while in order to repair the maxilla, we will first customize the “dental brackets” for the patient according to the preoperative 3D CT, and then perform organ reconstruction after the resection surgery to restore the patient’s function as much as possible.
In conclusion, modern medicine has developed not only advanced surgical methods but also excellent restorative methods, and the highest goal is always to cure the tumor and preserve the functional balance of the patient.
In addition, due to the development of nasal endoscopy technology, it is also possible to perform radical resection of earlier tumors under endoscopy, supplemented with radiotherapy and chemotherapy after surgery. This approach is one of the options to avoid facial wounds, with fast postoperative recovery and good results.
Prognosis: The prognosis of nasal sinus cancer varies according to the different locations, scope and pathological typing of the tumor, but in general, after regular treatment, i.e. the combination of surgery and radiotherapy, the 5-year survival rate of nasal septal sinus cancer is 60%-70% in the early stage and about 60% in the late stage. The 5-year survival rate of maxillary sinus cancer is 50%-60%.