Predictors of nodal metastasis in sinonasal squamous cell carcinoma: A national cancer database analysis

ObjectiveWe present the largest population based study of sinonasal squamous cell carcinoma (SCC) to identify risk factors for presentation with nodal metastasis.MethodsThe National Cancer Database (NCDB) was used for this study. Location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy were queried. Logistic regression analysis was performed to identify factors associated with presentation with nodal metastasis.Results6448 cases met inclusion criteria. Nodal metastasis at presentation was seen in 13.2% of patients, with the sinus subsite (19.3%) being a significant risk factor for nodal metastasis at presentation when compared to the nasal cavity (7.9%). Logistic regression analysis showed black, uninsured and Medicaid patients were more likely than white and privately insured patients, respectively, to present with nodal metastasis.ConclusionsIn sinonasal SCC, the sinus subsite has a significantly increased risk of nodal metastasis compared to the nasal cavity. Black race, uninsured and Medicaid patients are more likely to have nodal metastasis at presentation.     

Sarcomatoid carcinoma in the sinonasal cavity: A retrospective case series from a single institution

ObjectivesSarcomatoid carcinoma (SC) is rare in the sinonasal cavity with poor prognosis. This study aimed to summarize the clinical characteristics, treatment and prognosis of patients with sinonasal SC from a single tertiary medical center.MethodsRetrospective review of the clinical data of seven patients diagnosed with sinonasal SC from May 1988 to February 2021.ResultsSeven patients with SC in nasal cavity and paranasal sinus, including six males and one female, aged 34-77 years (mean, 58.3 years), were included in this case series. The common presenting symptoms included epistaxis and nasal obstruction. The tumor usually occurred in nasal cavity, maxillary sinus and ethmoid sinus. Most patients were diagnosed at advanced stages with the involvement of orbit and skull base. Open and endoscopic surgery were performed in five and two patients, respectively. The follow-up period ranged from 3 to 26 months. Four patients died of disease within one year, though two received adjuvant chemotherapy and one received radiotherapy. Two patients survived without recurrence at the end of follow-up, both of them underwent adjuvant radiotherapy. One patient received palliative re-irradiation due to local recurrence of the tumor three months after the surgery, however, this patient was lost to follow-up.ConclusionsSinonasal SC is a rare entity with an aggressive behavior and poor prognosis. Early diagnosis and multimodality treatment are recommended to improve the survival.     

Effects of endoscopic sinus surgery on nasal spray deposition using dye-based methods for humans and a human silicone sinonasal cavity model

ObjectiveWe have evaluated that the deposition patterns of corticosteroid nasal spray in the sinonasal cavity of both post-operated human cases, which were further compared with a computed tomography-based sinonasal airway model.MethodsFifty-one patients with chronic rhinosinusitis following an endoscopic sinus surgery were enrolled in this study. Nasal spray mometasone furoate hydrate (Nasonex®) containing 0.1% indigocarmine was applied to the patients' nasal cavities and the sinonasal cavity was observed by endoscopy and video documentation. A single plaster sinonasal model was used to quantify the sinonasal deposition of nasal sprays containing 10% red ink solution using 12 round paper strips.ResultsThe predominant areas of the spray deposition of the operated sinonasal cavities were recognized in the ethmoid sinus and the olfactory cleft in the human study. The droplets were mainly deposited in the inferior turbinate followed by the posterior part of the ethmoid sinus, the olfactory cleft, and anterior part of the ethmoid sinus in a sinonasal model.ConclusionThe corticosteroid nasal spray efficiently reached the olfactory cleft and the ethmoid sinus in post-operative conditions, which was demonstrated by post-operated human cases and a computed tomography-based sinonasal airway model.     

Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

ObjectiveThe aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinusesMaterial and methodsWe performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported.ResultsThe average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-yea adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002).ConclusionsCarcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.     

Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck

ObjectiveTo examine outcomes among patients treated for sinonasal undifferentiated carcinoma (SNUC) of the head and neck.Study designRetrospective review.MethodsThe records of 16 consecutive patients with newly diagnosed, non-metastatic SNUC were analyzed. Initial treatment consisted of: surgery alone (6 patients), surgery with post-operative chemoradiotherapy (4 patients), and primary radiation therapy with concurrent chemotherapy (6 patients).ResultsThe median survival for patients treated by surgery followed by postoperative chemoradiotherapy was 30 months compared to 7 months and 9 months for patients treated by surgery alone and upfront chemoradiotherapy, respectively (p = 0.20). The 2-year locoregional control was 18% for patients treated with upfront chemoradiotherapy, 37% for patients treated with surgery alone, and 78% for patients treated with surgery plus chemoradiotherapy (p = 0.49).ConclusionWhile the potential role of selection bias must be considered, multi-modality therapy using surgery and post-operative chemoradiotherapy yielded the most favorable outcomes for SNUC and should be recommended whenever feasible.     

Effects of unilateral sinonasal surgery on sleep-disordered breathing

Abstract

Aims/objectives: To examine the effects of surgery for unilateral sinonasal lesions on sleep-disordered breathing (SDB).

Material and methods: Oxygen desaturation index (3%ODI) as a marker of SDB and bilateral/unilateral nasal resistance were measured before and after surgery for 18 patients with unilateral sinonasal lesions. Various parameters were compared between those who achieved 60% or less decrease of 3%ODI and those who did not.

Results: Bilateral nasal resistance as well as that of the surgical side five days after surgery was significantly lower than those of pre-operative value. Preoperative 3%ODI (times/hour) was 10.08?±?7.32, which significantly decreased to 7.67?±?5.79 five days after surgery. Even in unilateral patients, sinonasal surgery could reduce the bilateral nasal resistance, resulting in a decrease in 3%ODI. Age was younger and postoperative nasal resistance of the surgical side was significantly lower in the group who achieved 60% or less decrease in 3%ODI than those who did not.

Conclusions and significance: SDB is influenced by even unilateral nasal obstruction. Surgery for unilateral lesion can improve the respiration during sleep as well as bilateral nasal resistance. Favorable outcome by surgery could be brought about in younger patients and those for whom sufficient improvement of nasal resistance was expected by surgery.     

鼻腔鼻窦非肠型腺癌6例临床分析

目的 以临床病例结合文献分析原发性鼻腔鼻窦非肠型腺癌（non-ITAC）的临床特性和病理免疫学特征,以期给临床医生在今后的诊疗中提供参考。方法 回顾性分析2014—2020年于北京协和医院经手术病理确诊的6例鼻腔鼻窦non-ITAC患者的临床资料和影像学、病理免疫学特点。结果 6例患者中男4例,女2例,年龄29~72岁,平均年龄54.8岁,其中4例为高级别non-ITAC,2例为低级别non-ITAC。临床表现以涕中或痰中带血、鼻塞等为主。4例男性均有吸烟史,其中1例工作中接触木屑较多。治疗方案为手术或术后加放疗或放/化疗。免疫组化结果：6例患者CK7均为阳性,其中4例患者P63为阴性;4例高级别non-ITAC患者Ki-67增殖指数为60%~90%,低级别non-ITAC患者Ki-67增殖指数1%~2%。随访至今,1例患者因肺转移死亡,其余患者均未有复发或转移。结论 鼻腔鼻窦non-ITAC患者临床表现及影像学对诊断有重要意义,病理免疫学对分级、治疗方案和预后有指导作用。     

Paraganglioma of the maxillary sinus

Primary paragangliomas of the paranasal sinuses are very rare conditions with only few cases described in the literature. Paragangliomas are locally aggressive, often recur and can metastasize. Usually, open surgery is used to resect such tumors from the sinonasal tract. Here, a case of a large paraganglioma of the left maxillary sinus and nasal cavity, which was successfully removed using the Onyx^® embolic agent two days prior to minimally invasive image guided endoscopic sinus surgery, is reported. This case demonstrates that large vascular tumors of the sinonasal tract can be successfully managed by endoscopic endonasal sinus surgery. The patient has no evidence of recurrence after 12 months of follow-up.     

Incidence and survival of sinonasal adenocarcinoma by site and histologic subtype*

Objective: To determine the incidence and survival of sinonasal adenocarcinoma (SNAC) by subsite and histologic subtype.

Study design: Retrospective database review.

Methods: Using the SEER database, we performed a retrospective analysis, identified cases of SNAC diagnosed between 1973 and 2013 and analyzed demographic, histopathology, clinicopathology, and determinants of disease specific survival (DSS).

Results: A total of 746 patients with SNAC were identified. Median age at diagnosis was 64 years. Overall incidence was 0.44 per million, and was higher among blacks (O.R.:1.10–2.07:1) and males (O.R.:1.38–2.06:1). Nasal cavity (41.5%) was the most common site, followed by maxillary (26.5%), and ethmoid (17.4%) sinuses. Intestinal-type adenocarcinoma was less likely than Adenocarcinoma not otherwise specified (ANOS) to be found in the maxillary sinus (8.8% vs. 30.6%, p?Conclusions: SNAC is more common among men and blacks. Incidence has not changed significantly in the past 40 years. Survival varies with grade, stage, histology, subsite, and treatment.     

Craniofacial resection for malignant nasal and paranasal sinus tumors assisted with the endoscope

Background

Craniofacial resection is regarded as the treatment of choice for paranasal malignant tumors invading the skull base. Even with this approach, the surgical view remains obscured when tumors in the deep nasal and paranasal sinuses are resected. Endoscopy provides a wide and clear surgical view in the deep and narrow nasal cavity. We report two patients who underwent craniofacial resection assisted with endoscope.

Methods

Two patients with malignant paranasal sinus tumor invading the anterior skull base underwent endoscope-assisted craniofacial resection.

Results

To avoid a limited surgical view in the sinonasal cavity, we performed craniofacial resection with endoscopic osteotomy and several procedures in the nasal cavity. The neurosurgeon performed anterior skull base osteotomy at an appropriate site from above, while the otolaryngologist provided illumination with the endoscope from below and preserved the adjacent structures. The patients recovered uneventfully and the endoscopic examinations of both patients 18 months after the surgery showed no recurrence.

Conclusions

Endoscopes were useful for the craniofacial resection at osteotomy, providing illumination from below and at the several procedures in the deep part of the nasal cavity. If a lateral rhinotomy incision is made, the combined transfacial and transnasal approaches avoid the limited working angle associated with the transnasal approach alone. Although an endoscopic approach is useful for treating sinonasal tumors, we should recognize its advantages and limitations.     

Ethmoid sinus cancer: Results of treatment with surgery and combined therapy

Objective—Ethmoid sinus cancer is a rare paranasal sinus malignancy. Its characteristics include a low incidence rate, a great variety of histopathological types and multiple treatment modalities. Currently, there remains no definite consensus regarding its optimal management. The aim of this study was to examine the outcome of a population of Asian patients with advanced ethmoid sinus cancers that had been treated with surgery plus combined therapy.

Material and Methods—Between January 1989 and December 2002 inclusive, 19 newly diagnosed patients with ethmoid sinus cancers who had undergone surgical intervention were enrolled, T4 being the principal carcinoma stage (68.4%). All participating cases proved to be node-negative and no evidence of any distant metastasis was detected at the time of diagnosis. The major treatment modality was surgery plus postoperative radiotherapy. All but 2 of the 13 patients with T4 cancer underwent craniofacial resection with pericranial flap reconstruction.

Results—The estimated overall and disease-free survival rates 3 years post-treatment were 49.4% and 26.3%, respectively. Local tumor recurrence was more common than regional recurrence and/or distant metastasis. A total of 5/15 T3–T4 patients (33%) developed a neck metastasis, 3 of whom also suffered a distant metastasis. There was no postoperative mortality for the cases treated with craniofacial resection.

Conclusions—Ethmoid sinus cancer typically demonstrates a propensity for late diagnosis and poor prognosis. This study confirms that craniofacial resection plus combined associated therapy is the optimal approach for the effective management of extensive ethmoid sinus tumors and is associated with an acceptable morbidity rate. More aggressive disease management featuring prophylactic concurrent chemoradiotherapy including neck or elective neck dissection plus chemotherapy should be considered for T3–T4 patients as opposed to T1–T2 patients.     

The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy

BACKGROUND: Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures. METHODS: Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session. RESULTS: Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640). CONCLUSION: These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.     

鼻腔鼻窦神经内分泌癌8例并文献复习

目的 探讨鼻腔鼻窦神经内分泌癌的临床特征、病理表现、治疗手段、预后及影响预后的因素.方法 回顾经病理证实的8例原发性鼻腔鼻窦神经内分泌癌患者的临床病例资料.结果 随访5～70个月,中位随访时间23个月,8例中典型类癌1例、不典型类癌4例、小细胞神经内分泌癌2例、复合型神经内分泌癌1例(低分化神经内分泌癌伴内翻性乳头状瘤...     

Treatment outcome of nasal and paranasal sinus carcinoma

PURPOSE: Most authors recommend aggressive management for sinonasal carcinoma treatment. In an attempt to determine the optimal treatment, we assessed the treatment results of our patients with nasal cavity and paranasal sinus carcinoma. MATERIALS AND METHODS: From January 1980 to December 2001, 40 patients with malignant tumours of the nasal cavity and the paranasal sinuses were treated. The median follow-up was 6 years. Thirty-two patients had tumours originating from the maxillary sinus. Thirteen patients had T1-T2 (32.5%) tumours and 27 patients had T3-T4 (67.5%) tumours. The treatment method was surgery plus radiotherapy in 24 patients (60%) and radiotherapy alone in 16 patients (40%). RESULTS: The 5-year overall survival rate was 61%, whereas it was 65% for T1-T2 disease and 56% for T3-T4 disease. The 5-year local control rate was 58%, whereas it was 75% and 50% (p = .219) for T1-T2 and T3-T4 disease, respectively. In multivariate analysis; localization (p = .016), adjuvant radiotherapy (p = .040), local control (p = .05), and gender (p = .013 for female) were statistically significant factors. CONCLUSION: The prognosis for patients with tumours of the sinonasal area is dependent on localization, tumour stage, and treatment modality. Because the most common site of treatment failure is the primary site, efforts to maximize local control should be undertaken.     

Semi-automatic segmentation of computed tomographic images in volumetric estimation of nasal airway

The objective of this study was to determine nasal cavity volumes and cross-sectional profiles from segmented coronal high-resolution computed tomography (HRCT) images. Pathological mucosal changes and congenital sinonasal variants were quantitated and three-dimensional (3D) images for determining sinonasal airway diseases evaluated by using the new semiautomatic segmentation software, Anatomatic. Anterior to posterior cross-sectional profiles of the sinonasal airway were obtained from acoustic rhinometry and segmented coronal HRCT images and compared in five patients having complaints of nasal obstruction and chronic sinusitis. Results showed that accurate volumes of air spaces in the nasal cavity and paranasal sinuses were obtained. When compared, the cross-sectional profiles of the nasal cavities obtained from acoustic rhinometry and the segmentation technique were similar in the anterior portion, but differed in the posterior portion. The results obtained by coronal HRCT and segmentation were more reliable than those produced with acoustic rhinometry. 3D images acquired from segmented images were found to help make a good pre-operative assessment of the whole sinonasal compartment. Segmentation and volumetric analysis using the Anatomatic technique also proved to be well suited to the evaluation of the nasal cavity and paranasal sinus geometry in patients with sinonasal diseases. Received: 5 March 1998 / Accepted: 9 June 1998     

A case of metastatic hepatocellular carcinoma in the nasal cavity

Metastatic hepatocellular carcinoma in the nasal cavity and paranasal sinuses is rare. We report the case of a 71-year-old male afflicted with hepatocellular carcinoma with metastasis in the maxillary sinus and nasal cavity. He underwent radiation therapy with a total dose of 36 Gy, but he died of terminal liver failure. The possible metastatic route and prognosis of metastatic hepatocellular carcinoma in the sinonasal tract are discussed.     

Reconstruction of the Orbit With a Temporalis Muscle Flap After Orbital Exenteration

ObjectivesThis study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration.MethodsA retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented.ResultsThe study included 13 patients (nine men, four women; age range, 30-82 years) with paranasal sinus, nasal cavity, or skin carcinomas. Primary reconstruction of the cavity was performed in all patients after orbital exenteration. No visible defects in the muscle flap donor site were present. Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients. Two patients died of systemic metastases and five died for other reasonsConclusionThe temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence.     

鼻腔鼻窦转移性肾透明细胞癌一例报道并文献综述

目的 探讨鼻腔鼻窦转移性肾透明细胞癌的临床特点及诊疗方法.方法 回顾性分析1例肾透明细胞癌转移至鼻腔鼻窦患者病历资料,并检索1993～2020年间国内外发表的相关文献,包括本例共有64篇文献76例患者纳入研究,总结其临床表现、诊断、治疗方法及预后.结果 76例中男61例,女15例.症状出现较多者为鼻出血58例、鼻塞25...     

Clinical characteristics of subglottic cancer: emphasis on therapeutic management strategies for stage II subglottic cancer*

Abstract

Background: Subglottic cancer (SGC) is extremely rare, as most laryngeal cancers are localized to the glottic region. Accordingly, the clinical characteristics of SGC have not been well characterized.

Objectives: In the current study, SGCs were clinically evaluated, and the outcomes of radiotherapy (RT) in patients with stage II SGC were assessed.

Materials and Methods: Medical data derived from 11 patients with SGC, who were treated at our hospital between 1995 and 2019, were retrospectively reviewed.

Results: In our department SGC accounted for 3.9% of the 280 laryngeal cancer patients treated during the study period. At the time of SGC diagnosis, 9 (81.8%) had stage II cancer, 1 had stage III cancer, and 1 had stage IV cancer. Stage II SGC patients treated with concurrent chemoradiotherapy (CCRT) showed a significantly higher local control rate (p?=?.026) and laryngeal dysfunction free rate (p?=?.026) than those treated with RT alone. Salvage surgery, performed in 4 patients whose disease was not locally controlled with CCRT/RT, was successful in 3 patients.

Conclusion: As a treatment strategy for stage II SGC, CCRT is an acceptable initial treatment for laryngeal function and preservation while salvage surgery is effective for recurrence after CCRT/RT treatment.     

Influencia de la premedicación con esteroides sistémicos en el sangrado y visualización del campo quirúrgico durante la cirugía endoscópica nasosinusal

IntroductionChronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS).Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure.MethodsNon-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded.ResultsEach group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly.ConclusionsEven though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.