Two patients with ethmoid sinus carcinoma were treated with a combined intracranial and facial approach.
Case 1: A 39-year-old man complained of right nasal obstruction and headache for three months. CT scan and MR imaging of his face revealed a mass arising within the right ethmoid sinus and, involving the right nasal cavity, the right medial orbit and the anterior cranial base. Intranasal biopsy of the mass showed a moderately differentiated squamous cell carcinoma. He received FAR treatment, a combination of vitamin A, 5FU and radiation, preoperatively.
Operation was performed by a team (otolaryngologist, plastic surgeon and neurosurgeon). With a combined intracranial and facial approach, the tumor was resected with the bilateral anterior cranial fossa floor, adjacent dura mater and right medial orbital wall. The anterior skull base and the nasal cavity defects were reconstructed with a calvarial bone flap and a free forearm flap.
Ten days after surgery, a second operation was performed bacause of local infection and meningitis. The necrotic galeo-periosteal flap and the temporal fascia were replaced with a frontal muscle flap and lyophilized dura, respectively.
After the patient recovered from meningitis, he was treated with radiation and chemotherapy (5FU and CDDP). He died of local recurrence 7 months later.
Case 2: A 68-year-old man had a 2-year history of right nasal obstruction. CT scan and MR imaging of his face revealed a mass arising within the right ethmoid sinus, involving the right nasal cavity, the right medial orbit and the anterior cranial base. Intranasal biopsy showed well-differentiated squamous cell carcinoma. Radiation therapy was given to the patient preoperatively.
After extirpation of the tumor involving with right orbital content and the anterior skull base, the defect was reconstructed with a free abdominis flap only. Postoperatively he was treated with chemotherapy (5FU and CDDP).
This patient has been followed up for 1 year and shows no evidence of recurrence of the disease.