29 Rhinoplasty after Tumor Surgery
The most common malignant tumors that occur in the nose and paranasal sinuses are epithelial tumors such as squamous cell carcinoma, adenoid cystic carcinoma, and adenocarcinoma. A rare malignant tumor arising from the olfactory epithelium is esthesioneuroblastoma. Mesenchymal tumors such as sarcomas are also rare. The closer the tumor is located to the skull base, the less favorable its prognosis. The nasal cavity is a relatively common site for squamous cell carcinoma arising from inverted papilloma, as in the case described below. The cardinal symptoms are nasal obstruction, epistaxis, hyposmia, headache, and possible earache due to impaired middle ear ventilation. Many patients seek medical attention too late, when the tumor has already reached an advanced size (T2 or larger). All possible oncologic treatment options such as adjuvant chemoradiation, conventional or fractionated radiation, and CyberKnife therapy should be discussed and coordinated in an interdisciplinary case conference before treatment is initiated. (Please find more information on this topic in chapter 34.)
Case 45
Introduction
A 48-year-old woman presented in 2005 with a nasal septal mass encroaching on the undersurface of the middle vault. In 1999, she had undergone the resection of an intranasal inverted papilloma. The latest tumor resection was a histographically controlled excision that identified the lesion as adenoid cystic carcinoma. An R0 resection was achieved and was confirmed in histologic follow-ups. Postoperative care was followed by adjuvant radiation. Subsequent staging tests consistently confirmed an R0 M0 N0 status. The patient, a heavy smoker, died from an acute pulmonary embolism in 2011.
Findings
Frontal view ( Fig. 29.2a ) shows a deformed nasal dorsum following resection of the bony and cartilaginous nasal skeleton. Profile view ( Fig. 29.2b ) shows dorsal saddling of the nose with a pseudohump and alar retraction.
The patient 5 years after the revisions ( Fig. 29.2f ).
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