Sinonasal malignancies are rare cancers that present significant diagnostic and management challenges. As tumors with a diverse histologic spectrum and wide-ranging clinical behavior, they often present at advanced stages, involving anatomically complex regions that are difficult for the surgeon to navigate. Sinonasal tumors straddle critical areas that influence the physiology of mastication, speech, swallow, nasal continence, vision, and central nervous function. These tumors and their treatment therefore commonly inflict high morbidity and mortality.
Optimizing care to maximize disease control, function, and cosmesis requires a dedicated multidisciplinary team of surgeons, radiation oncologists, medical oncologists, as well as specialists to facilitate post-treatment rehabilitation. Reliance on expert imaging and pathology is critical to selection of treatment. Overall, successful management is predicated on understanding tumor biology and practicing sound oncologic principles to produce the best outcomes by balancing control of disease against preservation of function and quality of life (QOL).
ANATOMY AND PATHWAYS OF TUMOR SPREAD
The nasal cavity serves as the inlet to the upper airway, beginning at the anterior nares and ending at the posterior choanae that open into the nasopharynx. It provides a portal of entry that filters, humidifies, and warms incoming air traveling to the lungs. The nasal cavity is divided in the midline by the nasal septum, which is composed of the septal cartilage and the vomer bone, lined on each side by the nasal mucosa.
The nasal cavity confines are partly cartilaginous and partly bony, and its floor is purely bony. Laterally, the nasal cavity contains the nasal conchae. The inferior concha is part of the nasal cavity, while the superior and middle conchae are composite parts of the ethmoid complex. The mucous membrane lining the nasal cavity is densely adherent to the underlying periosteum and perichondrium. The majority of the mucous membrane is pseudostratified columnar ciliated epithelium of the Schneiderian type. The lining is highly vascular and contains mucous glands, minor salivary glands, and melanocytes.
The olfactory neuroepithelium that is responsible for the sense of smell overlies the cribriform plate in the roof of the nasal cavity. The lateral nasal wall bears the conchae (or turbinates), and the meati (or air spaces) between them contain the openings of the paranasal sinuses. The inferior meatus is located below and lateral to the inferior concha and receives the opening of the nasolacrimal duct on the anterior portion of its lateral wall. The ostium of the maxillary sinus opens into the ethmoidal infundibulum of the middle meatus, whereas the sphenoid sinus drains into the sphenoethmoidal recess above the uppermost concha.
The blood supply to the nasal cavity is from branches of the external carotid arteries (sphenopalatine branches of the internal maxillary artery and facial artery) and internal carotid arteries (anterior and posterior ethmoid branches of the ophthalmic artery). The veins of the nose arise in the dense venous plexi that are especially concentrated ...