Treatment of Malignant Growths of the Nasal Accessory Sinuses and Nasopharynx

Abstract

IT is not the purpose of this discussion to present a detailed review of all phases of treatment of tumors of the accessory sinuses and nasopharynx but rather to call attention to a few of the more outstanding factors in treatment. For the most part, attention will be directed only to the malignant growths in these locations. Probably no location in the body presents so many complicating factors as are to be found centered immediately about the nasal passages. A wide range of tumor type is possible. The primary site or origin. of growth is often difficult and frequently impossible to determine; bone and cartilage involvement is hard to define; interference with sinus drainage and infection give rise to inflammatory tissue which it is often impossible to differentiate clinically from tumor tissue. The peculiar anatomy of the paranasal sinuses favors inflammatory processes. How much this contributes as a predisposing cause in the development of many of the growths is, of course, not known: certainly it is an important factor. Inflammatory processes alter the normal type of tumor growth and influence unfavorably the protective cellular reactions in the surrounding normal tissue. Mixed infection, with the resulting inflammatory processes, complicates diagnosis. It adds to the surgical risk and aggravates tumor growth. Osteomyelitis almost invariably accompanies tumor invasion of bone, interfering with the reaction to the physical agents of normal tissues about the growth. More patients with these involvements succumb to fatal infection than do those subject to the natural progress of the disease. Histology The complex embryology of the parts under discussion affords opportunity of tumor origin from many developmental anomalies; hence a wide range of tumor type is met with. In his book on “Neoplastic Diseases,” Dr. Ewing has enumerated thirty-seven varieties of growths found in or about the nasal passages, anyone of which is capable of blocking them. A great many of the growths falling in this general group are intimately associate with the maxillary antrum. Whether most of the tumors referred to as antrum growths are primary or are secondary extensions from other sinuses or the nasal passages is frequently not understood. Inflammatory processes often mask the true picture. In our own experience, these cases are usually so far advanced that the exact site of origin cannot be determined with any degree of accuracy. In a group of 136 malignant growths of the antrum examined in our service between 1917 and 1929, 83 per cent were so far advanced as to be inoperable by radical excision of the superior maxilla. Under such circumstances of advanced growth it is obviously impossible to determine with any degree of accuracy what the actual primary site of growth was. Carcinoma is the predominating type of tumor. A cylindrical cell carcinoma of adenocarcinomatous structure is most common in all of the sinuses. It is rapid in growth, bulky, and bleeds easily.