Risk of sinonasal‐cutaneous fistula after treatment for advanced sinonasal cancer

Abstract

BACKGROUND AND OBJECTIVES: To determine the rate and the risk factors for sinonasal-cutaneous fistula formation after treatment for sinonasal malignancy. METHODS: Between 1991 and 2002, 99 patients with advanced sinonasal malignancy received radiation therapy +/- surgery. Primary site was maxillary sinus in 30, ethmoid sinus in 19, nasal cavity in 32, nasopharynx in 3, and sphenoid sinus in 15 patients. Eighty-two percent of patients had T4 disease. Sixty-eight percent of patients had undergone surgical resection. Median follow-up was 70.6 months. RESULTS: Eight patients developed ≥ grade 3 sinonasal-cutaneous fistulas at a median time of 3.8 months after radiation. The overall rates of developing ≥ grade 3 fistulas in the entire group at 2 and 5 years were 6% and 10%, respectively. The fistulas were in the medial canthus in seven patients and in the infraorbital region in one patient. Fistulas developed exclusively along the transfacial incision scar and in patients whose tumors extended to the subcutaneous tissues. In univariate analysis, squamous cell carcinoma histology (P ¼ 0.008), ≤ T4a primary tumor category (P ¼ 0.02), and transfacial incision (P ¼ 0.02) were associated with increased risk of fistula formation. CONCLUSIONS: Histologic subtype, T category, and quality of the skin and the underlying supporting tissues after transfacial incision are risk factors for sinonasal-cutaneous fistula formation.