Nasal Cavity and Sinus Surgery
The paranasal sinuses are air-filled sacs:
- Maxillary sinuses are under the eyes in the cheek bones.
- Frontal sinuses are above the eyes in the forehead area.
- Ethmoid sinuses are between the nose and the eyes.
- Sphenoid sinuses are in the skull base, under the pituitary gland.
The purpose of the paranasal sinuses is not known for certain, but scientists believe the air-filled sacs have several functions:
- To decrease the weight of the skull
- To increase voice resonance
- Protection against blows to the face
- Insulation of the eyes and roots of the teeth against temperature fluctuations
- To humidify and heat inhaled air
Surgery is needed to remove the cancer and some of the surrounding bone or other nearby tissues. The amount of tissue that needs to be removed depends on the type and stage of the cancer.
Surgeons remove the entire tumor, and a small amount of normal tissue, while trying to maintain the appearance of the face. Some of the normal tissue is removed so cancer cells do not remain in the nearby tissues. The expert surgical techniques of our surgeons allow breathing, speech, chewing, and swallowing to remain as normal as possible.
Nasal Cavity Cancer Surgery
Nasal cavity cancers are usually removed by a wide local excision. A wide local excision includes the area around the tumor to assure all cancer cells are removed:
- Nasal septum. If the tumor involves the dividing wall of the nasal cavity (the nasal septum) either a portion or the entire septum is removed.
- Nasal cavity. If the tumor is growing on the side wall of the nasal cavity, the wall must be removed. Sometimes the surgeon can remove the tumor by cutting under the upper lip so visible incisions are not needed. If this is not possible, the surgeon will cut through the skin on the side of the nose. Then the skin and nose are folded back to remove the tumor.
- If the cancer has grown into the tissue, part of the nose or the entire nose might need to be removed. A reconstructive surgeon rebuilds the nose with the surrounding facial tissues or from artificial materials (prosthesis).
Paranasal Sinus Surgery
- Ethmoid sinuses. If the tumor is very small, and is located within the ethmoid sinuses only, the surgeon can remove the tumor through the nostril with an endoscope (a thin lighted tube). If the tumor is much larger, an incision on the side of the nose may be necessary.
- Maxillary sinus. If the tumor involves the maxillary sinus, a maxillectomy is needed. The type of maxillectomy depends on the exact location of the tumor. If the tumor is small and toward the middle of the sinus, the surgeon can remove the tumor through the nostril with an endoscope. If the tumor is larger, the surgeon will make the incision along the side of the nose or under the upper lip. The surgeon might need to remove bone from the hard palate, the upper teeth on one side of the mouth, part or all of the orbit (eye socket), part of the cheekbone, and/or the bony part of the upper nose.
A craniofacial resection may be needed if the cancer involves the ethmoid sinuses, frontal sinuses, and the sphenoid sinuses.
A craniofacial resection requires both a head and neck surgeon and a neurosurgeon.
If the tumor is located in the roof the nasal cavity, and invades into the brain, surgeons will need to remove the tumor from the nose and the brain.
Endoscopic surgery is less destructive to normal tissue than conventional operations. The surgeon inserts a thin lighted tube (endoscope) into the nasal cavity, or sinus, instead of opening the area with an incision. The image is enlarged on a computer screen. Small (micro) instruments are used with the endoscope.
Surgeons are using the endoscopic method increasingly more often for treatment of nasal tumors, ethmoid tumors, and for nasal cavity cancer.
Radiation treatments are usually needed after surgery.
If cancer has affected the lymph nodes in the neck, a neck dissection (removal of the lymph nodes) might be needed during any type of head and neck cancer surgery.
Radiation therapy stops cancer cells from dividing. The growth of the tumor is slowed. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors.
Medical oncologists administer chemotherapy if the cancer has spread to lymph nodes or other organs. The medicine circulates in the blood and disrupts the growth of the cancer cells. Chemotherapy medications are taken by mouth or given through a vein for several months.
Chemotherapy is prescribed for different reasons:
- Together with radiotherapy as an alternative to surgery (called chemoradiation)
- After surgery to decrease the risk of the cancer returning
- To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment).
The combination of surgery, radiation or chemotherapy depends on the size, the location and the type of tumor.