Ten Years' Experience with Radical Combined Craniofacial Resection of Malignant Tumors of the Paranasal Sinuses

Abstract

ALIGNANT tumors of paranasal sinuses account for but a small percentage of human neoplastic disease. This amounts to about 3 % of all cancer of upper respiratory and alimentary tracts or approximately 0.2 % of all human cancers. TM Watson TM found an incidence of 0.44 % of cancer of paranasal sinuses in a total of 26,062 patients admitted for malignant disease at Memorial Hospital. Nevertheless, serious study of these patients is merited not only because of peculiarly unpleasant suffering these patients undergo in terminal period but because it has been found practical to eradicate disease in a relatively high proportion of patients. It should be re-emphasized that only histologically malignant tumors are under present consideration. From a statistical point of view, several features suggest that radical therapy should provide a high cure rate. Some 80 % of tumors of paranasal sinuses are estimated to arise in maxillary sinus which has long been considered a surgically accessible site. 1 The tumors, appearing as they most commonly do in fifth to seventh decade, are predominantly carcinomas or adenocarcinomas and frequently of slow-growing type. 8 Certainly one of greatest difficulties in treatment is diagnosis of tumor in an early stage. Often, many months of symptomatic treatment is prescribed for protean symptoms of nasal obstruction, local pain, and epistaxis before a definitive diagnosis of malignancy is made. Despite late diagnosis, metastases are relatively uncommon. Of 68 patients with cancer of nasal cavity, MacComb and Martin ~x found that 12 % had metastases on admission and only 17% had metastases later in their course. This incidence is approximately same as that of Ashley Received for publication July 13, 1967. and Schwartz I who noted at autopsy that only 25 % of maxillary carcinomas spread beyond local area. Metastases usually appeared in retropharyngeal and superior cervical lymph nodes if primary tumor was in superior and medial portion of antrum. Tumors involving floor and lateral wall were more prone to show metastases in submandibular lymph nodes. Taken together, these features encourage surgical attack upon local lesion. Unfortunately, hopes of an en bloc resection through a facial approach can only be realized in cases with very small lesions, since tumors, even if primary in antrum, seldom remain there. The common extension of tumor into ethmoidal sinus and impossibility of removing this sinus en bloc through a facial approach is a particular deterrent to resection, since even as late as 1963, FrazeU and Lewis 6 warned that the entire cribriform plate can rarely be resected without creating cerebral complications ....