Tumours
of the nose
Benign
tumours
Osteomas of the nasal skeleton are not uncommon
and are usually detected on X-ray as an incidental finding. They are usually
seen in the frontal and ethmoid sinuses (Fig. 39.14). Some may produce symptoms
such as headache or recurrent sinusitis if the location interferes with the
drainage of one of the paranasal sinuses. Plain X-rays demonstrate a calcified,
well-demarcated tumour of variable size. In symptomatic individuals the osteoma
can be removed via the frontal sinus or an external ethmoidectomy.
Transitional
cell papilloma (inverted papilloma) can occur in both the nasal cavity and the
nasal sinuses. They can be quite extensive (Fig. 39.15) and give rise to nasal
obstruction and sometimes epistaxis. Although usually unilateral, red, firm and
vascular they can sometimes look like simple nasal polyps, and in 25 per cent of
cases the diagnosis is made by the pathologist after a routine nasal polypectomy.
When large they can erode the lateral nasal wall and infiltrate the antrum and
ethmoid. Calcification within the tumour may be seen on CT scanning along with
sclerosis of bone at the margins of the growth. Transitional cell papilloma can
undergo malignant change; synchronous lesions occur in 5—10 per cent, while
metachronous lesions develop in 1 per cent of cases.
For
this reason more radical surgery is employed than for simple polyps to ensure
complete removal of all papillomata and will usually involve a partial
maxillectomy.
•
Transitional papilloma may undergo malignant change
Malignant
tumours
Skin tumours involving the nose are not
uncommon. Basal cell carcinomas (rodent ulcer) are confined to the head in 86
per cent of cases and of these 26 per cent occur on the nose. Adequate surgical
excision may require some form of reconstructive flap procedure to eliminate the
resulting defect. Keratinising squamous cell carcinoma is the second most common
tumour of the external nose, which should be adequately excised with a generous
margin of healthy skin and the defect reconstructed with a local flap. About 10
per cent of all melanomas occur in the head and neck. Wide
The
most common tumours to occur within the nasal cavity and paranasal sinuses are
squamous cell carcinoma (Fig. 39.16), adenoid cystic carcinoma and adenocarcinoma.
(Table 39.3). Presenting symptoms include unilateral nasal obstruction, chronic
nasal discharge, which is often haemorrhagic and offensive, and loss of skin
sensation on the face (trigeminal nerve). There may be swelling of the cheek,
buccal sulcus or the medial canthus of the eye and a feeling of fullness or
pressure within the nose or face. Suspicious signs of invasion of neighbouring
tissues include diplopia, proptosis, loosening of the teeth (Fig.
39.17), trismus, cranial
nerve palsies and regional lymphadenopathy.
Patients
with sinus or intranasal malignancy are best managed in a combined clinic where
the expertise of ear, nose and throat (ENT) surgeons, maxillofacial surgeons and
radiotherapists can be employed. Detailed surgical management is outside the
scope of this book, but the adequacy of any surgical resection will need to be
confirmed by frozen section control of soft-tissue margins. Inevitably
reconstruction will require the use of myocutaneous flaps or
Malignant nasal tumours —
summary
•
Skin cancer of the nose requires wide excision and expert reconstruction
•
May present late with signs of invasion
•
Should be managed by ENT and maxillofacial surgeons with a radiotherapist