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Surgery of cancer of the nasal cavity and paranasal sinuses

Surgery may be sufficient treatment for small tumors. Larger tumors usually require a combination of surgery and radiation therapy (5).

Access and extent of surgery is determined by the extent of the tumor.

  • Lateral rhinotomy involves removal of bone equivalent to the upper contents of the maxillary fossa and medial orbital wall. This entry provides good overview of the nasal cavity and ethmoidal region. 
  • Midfacial degloving provides wide access to the bone of the upper jaw. An incision is made in the sublabial mucosa where skin, subcutaneous tissue, and periosteum are removed from the surface of the upper jaw. 

Resections

  • Resection of the nasal septum
  • Low maxillary resection
  • Resection of the lower contents of the maxillary sinus
  • Resection of the upper contents of the maxillary sinus
  • Ethmoidectomy
  • Resection of ethmoidal region
  • Craniofacial resection of the anterior skull base

MRI of advanced tumor in right maxillary sinus with infiltration of the nasal and orbital cavities. Click to enlarge. Intraoral view after complete maxillary resection. Click to enlarge. Obturator prosthesis.
Click to enlarge.

 

The empty orbital cavity is covered with skin taken from a thigh. The patient has magnetic implants to attach the prosthetic eye.
The prosthetic eye is now in place.

Tumors in the ethmoidal region are resected using combined facial and transcranial access (10). Such combined procedures have improved the prognosis for these tumor types considerably.

Patient with external nose amputated. 
Nasal prosthesis attached to a pair of eyeglasses. The patient now has a loose prosthesis that is held in place by magnets.

 

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