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Head and Neck Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Lorcan O’Toole, Nicholas D. Stafford
Many tumors involve bone or cartilage, and primary surgery is therefore the preferred treatment. A lateral rhinotomy provides excellent access to tumors arising from the lateral nasal wall or septum. Endoscopic resection can be considered in some cases.
Common paediatric ENT viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Benjamin Hartley, Richard J Hewitt
Surgery can be endoscopic or open. Typically stage I and II disease is managed via an endoscopic approach. Stage III and IV disease is managed via an open approach. Increasingly stage III disease have been attempted endoscopically. A combined approach can also be considered. Regardless of technique, tumour should be fully resected. Open approaches include lateral rhinotomy, transfacial, transpalatal and infratemporal fossa. Midfacial degloving is used in many units as it gives considerable access.
Case 66
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
Open surgical resection has historically been the mainstay of treatment although increasingly, endoscopic approaches have been used for tumours as large as Radkowski stage IIIa. Open approaches include transpalatal, lateral rhinotomy and midfacial degloving techniques. Endoscopic resection has the advantage of less bleeding, less morbidity, shorter hospital stay and similar recurrence rates to open surgery. Endoscopic resection does, however, become challenging in tumours with lateral invasion of the infratemporal fossa. Combined endoscopic and open approaches may be used in some cases. Guidance regarding endoscopic approaches has been provided in the European position paper on endoscopic management of tumour of the nase and paranasal sinuses. All surgery should be preceded with embolisation of the feeding vessels 24 to 48 hours pre-operatively. Recurrence tends to occur at the basi-sphenoid, particularly around the Vidian canal and this region should be drilled out to minimise recurrence risk.
A clinical analysis of sinonasal squamous cell carcinoma: a comparison of de novo squamous cell carcinoma and squamous cell carcinoma arising from inverted papilloma
Published in Acta Oto-Laryngologica, 2020
Ryuji Yasumatsu, Rina Jiromaru, Takahiro Hongo, Ryutaro Uchi, Takahiro Wakasaki, Mioko Matsuo, Masahiko Taura, Takashi Nakagawa
In general, our policy is to treat sinonasal SCC surgically whenever possible. Patients with de novo SCC underwent either definitive resection with curative intent or debulking surgery. The goal of definitive resection was to achieve negative surgical margins. Debulking surgery was performed in a piecemeal fashion within the sinonasal cavity to improve symptoms, such as visual loss, diplopia, and headache. The surgical technique to achieve negative surgical margins varied based on the location of the tumor. From 1990 to 2004, tumors infiltrating the orbital fat were treated with orbital exenteration. Tumors involving the floor of the nose, hard palate, or maxillary sinus were treated with a maxillectomy and/or lateral rhinotomy. Skull base surgery was performed in patients with skull base invasion. From 2005 to 2016, they underwent external excision combined with an endoscopic approach. Regarding patients with IP-SCC in whom SCC could not be diagnosed by preoperative biopsy, they underwent external excision from 1990 to 2004 and endoscopic and/or external excision from 2005 to 2016. All patients with neck lymph metastasis underwent neck dissection along with treatment of the primary lesion.
Nasal vestibule squamous cell carcinoma: a population-based cohort study from DAHANCA
Published in Acta Oncologica, 2022
Mads V. Filtenborg, Jacob K. Lilja-Fischer, Maja B. Sharma, Hanne Primdahl, Julie Kjems, Christina C. Plaschke, Birgitte W. Charabi, Claus A. Kristensen, Maria Andersen, Elo Andersen, Christian Godballe, Jørgen Johansen, Jens Overgaard, Kristian B. Petersen
The Danish treatment guidelines [3] recommend single treatment modality, either surgery or EBRT, to T1 tumours with respect of cosmetic outcome and nasal function, whereas T2-4 tumours should be treated with EBRT as single treatment modality or in combination with initial surgery. Surgery consist of endoscopic endonasal resection and lateral rhinotomy, whereas nasal amputation are preserved as salvage procedure. The EBRT recommended dose is 66 Gy in 33 fractions, or in small T1 tumours hypofractionated treatment with 54 Gy in 18 fractions. Chemotherapy and elective neck irradiation is not recommended in the Danish treatment guidelines for either nasal vestibule cancer or SCC of the skin.
Unusual cases of sinonasal malignancies: a letter to the editor on HPV-positive sinonasal squamous cell carcinomas
Published in Acta Oncologica, 2023
Benedicte Bitsch Lauritzen, Sannia Sjöstedt, Jakob Myllerup Jensen, Katalin Kiss, Christian von Buchwald
Four years after the CUP diagnosis, the patient presented with nasal stenosis and ulceration on the left side of the nasal septum. Due to her history, an FDG-PET/CT was performed, and based on the findings a biopsy was obtained from the nasal ulceration. The latter demonstrated HPV-positive SNSCC, T1N0M0, containing the same HPV-type as her previous head and neck CUP. In agreement with our pathologists, the primary tumour was finally identified i.e. four years following her initial cancer diagnosis. Subsequently, a lateral alar rhinotomy, with resection of most of the nasal septum, was performed followed by local postoperative radiation therapy (RT).