For most nasal cavity or paranasal sinus cancers, surgery to remove the cancer (and some of the surrounding bone or other nearby tissues) is an essential part of treatment. If the cancer has spread to the lymph nodes of the neck, the surgeon may also remove lymph nodes by an operation called a neck dissection. Often, surgery is combined with radiation to get the best result. The role of chemotherapy is being studied.

The anatomy of the nasal cavity and paranasal sinuses is extremely complex. Many important nerves, blood vessels, and other structures are located in and around the nasal cavity and paranasal sinuses.

Closeness to the brain, eyes, mouth, and carotid arteries (arteries that supply blood to the brain) makes surgical planning and surgery itself difficult. Also, how the face looks and functions after surgery must be taken into account. The goal of surgery in these areas is to remove the entire tumor and a small amount of normal tissue around it while keeping appearance and function (such as breathing, speech, chewing, and swallowing) as normal as possible.

Unfortunately, these cancers often involve the eye or orbit (the bone and tissue surrounding the eye) by the time they are noticed or cause symptoms. Most of the time the eye can be saved, but occasionally the entire orbit and eye may need to be removed to give the best chance for cure.

Nasal cavity cancers

Nasal cavity cancers are often removed by a procedure called wide local excision. This means removing the tumor plus an area of normal tissue surrounding it. The goal is to remove enough tissue so that no cancer cells remain. If the tumor involves the middle dividing wall of the nasal cavity (the nasal septum), sometimes the entire septum or a large portion of it will be removed.

If the tumor involves the lateral (side) wall of the nasal cavity, often this wall must be removed by a procedure called a medial maxillectomy. For this operation, the surgeon will usually cut through the skin along the side or edge of the nose and fold the external nose toward the opposite side to see and work on the tumor. Then the side of the nose can be removed by cutting the bone and soft tissue as needed. Sometimes, if the cancer is in a certain position, the surgeon can reach the tumor by cutting under the upper lip. This approach has the advantage of avoiding any skin incisions.

Discuss which approach or incision you may need with your head and neck surgeon. If the cancer involves the skin or deeply invades the tissue of the external nose, part (or all) of the nose may need to be removed. There are many ways to rebuild the nose with surrounding facial tissues. Or a cosmetic prosthesis (artificial materials) may be used to make a new nose.

Paranasal sinus cancers

Operations for paranasal sinus tumors vary, depending on the tumor's specific type, location, size, and involvement with other structures.

If the tumor is very small and/or benign and is located within the ethmoid sinuses only, an external ethmoidectomy may be performed. The surgeon performing this operation will cut through the skin on the upper side of the nose next to the upper eyelid. Bone on the inner side of orbit (eye socket) and nose will be removed to reach tumors inside the ethmoid sinuses.

If the tumor also involves the maxillary sinus, a maxillectomy may be performed. There are several types of maxillectomies that may be performed depending on exactly where the tumor is and whether it also involves nearby tissues. These procedures may involve an incision along the side of the nose from the eyebrow or upper eyelid down to or through the upper lip. Or the incision may be made under the upper lip as discussed above. The bones around the maxillary sinus are cut so that the entire tumor and some surrounding tissue can be removed in one piece. This operation may remove bone from the hard palate (the roof-of the mouth), 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.

If the cancer involves the ethmoid sinuses, frontal sinuses, and/or the sphenoid sinuses, an operation called a craniofacial resection may be performed. This operation is similar to a maxillectomy except that the operation may also remove upper parts of the eye socket and the front of the skull base. This procedure is extensive and usually involves a surgical team including an otolaryngologist (head and neck surgeon) and a neurosurgeon.

Endoscopic surgery

In endoscopic surgery, the surgeon uses an endoscope (a thin, flexible lighted tube inserted into the nasal cavity or sinus) to see and remove the tumor. That way, the surgeon does not have to cut through bone to open up the whole cavity. This reduces the actual amount of normal tissue destroyed. Endoscopic surgery is most often used for smaller tumors. For larger tumors, it may be used to help treat people who are not healthy enough for a bigger operation. Usually it is combined with radiation treatment. Endoscopic approaches to remove nasal and sinus cancers are being used more commonly as an increasing number of surgeons are trained in these techniques. Some medical centers have more experience with endoscopic surgery for nasal and sinus cancers.

Neck dissection

Cancers of the nasal cavity or paranasal sinuses sometimes spread to the lymph nodes in the neck. Depending on the stage and exact location of the cancer, it may be necessary to remove these lymph nodes by an operation called a neck dissection. There are several types of neck dissection procedures and they differ in the amount of tissue removed from the neck. Their goals are to remove lymph nodes proven or likely to contain metastatic cancer. The amount of tissue removed depends on the primary cancer's size and extent of spread to lymph nodes.

• A partial or selective neck dissection removes only a few lymph nodes.

• A modified radical neck dissection removes most lymph nodes on one side of the neck between the jawbone and collarbone, as well as some muscle and nerve tissue.

• A radical neck dissection removes nearly all nodes on one side as well as even more muscles, nerves, and veins.

The most common side effects of any neck dissection are numbness of the ear (caused by injury to the greater auricular nerve), weakness in raising the arm above the head (caused by injury to the spinal accessory nerve), and weakness of the lower lip (caused by injury to lower branches of the facial nerve). After a selective neck dissection, the weakness of the arm and lower lip usually resolve after a few months. But if either nerve is removed as part of a radical neck dissection or because of tumor spread then the weakness will be permanent. After any neck dissection procedure, physical therapists can teach the patient exercises to improve neck and shoulder movement.

Last Medical Review: 08/13/2009
Last Revised: 08/13/2009