Surgical Management of Sinonasal Cancers: A Comprehensive Review

Abstract

Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, specific criteria related to the tumor (tumor extensions, tumor pathology), the patient, or the surgeon himself. The aims of this review are (i) to provide a complete overview of the surgical techniques available for the management of sinonasal malignant tumors, with a special focus on recent developments in the field of transnasal endoscopic surgery; (ii) to summarize the criteria that lead to the choice of one technique over another. In particular, the oncological outcomes, the morbidity of the different techniques, and the specificities of each histologic subtype will be discussed based on a comprehensive literature review.

The Selective Role of Open and Endoscopic Approaches for Sinonasal Malignant Tumours

“…Lateral rhinotomy [ 89 ] primarily provides access to the maxilla, ethmoid, sphenoid, and may also provide access to the frontal sinus and anterior skull base when combined with other incisions. By performing various osteotomies, it is possible to expose the ventral skull base, the infratemporal fossa and to control the internal carotid artery [ 90 ]. Lip-splitting incision, which does not seem to be of great advantage, should be avoided whenever possible to avoid cosmetic sequelae.…”

“…Subsequently, a frontal craniotomy is performed through a coronal incision, the frontal lobe is retracted, and the floor of the anterior cranial fossa is exposed up to the dorsum of the sella turcica. Transfrontal craniotomy may include resection of the anterior and posterior frontal walls, or a frontal osteoplastic flap may be performed, which decreases the risk of osteomyelitis [ 90 ]. To avoid frontal cerebral lobe retraction, a subcranial approach can be used.…”

Mismatch Repair Deficiency and Somatic Mutations in Human Sinonasal Tumors

“…Based on unspecific or mild symptoms at early stages of tumor development, sinonasal cancers have a prolonged diagnostic latency [ 2 , 3 ]. Over the past decade, advances in imaging techniques, surgical approaches (especially endoscopic interventions) and radiotherapy have contributed to better management of patients with sinonasal tumors [ 4 , 5 ]. Due to the anatomic area closely related to the central nervous system, local treatment options are limited and systemic neoadjuvant or adjuvant therapies have a pivotal role in improving the outcome of patients treated with a curative intent [ 6 ].…”

Sinonasal Cancer: Improving Classification, Stratification and Therapeutic Options

“…Salfrant et al present a detailed description of pre-surgery imaging with regard to tumor extension and invasion into the orbit and brain, which is relevant for prognostic evaluation and treatment planning [ 45 ]. Chatelet et al provide a complete overview of surgical techniques, the criteria to choose which ones to apply to sinonasal tumors to and the clinical outcomes and morbidities of the different techniques [ 46 ]. Gallioni et al focused on the challenges with managing possible lymph node metastases in the neck region, whose incidence differs among the sinonasal cancer subtypes and increases during follow-up.…”