Craniofacial resection in the management of paranasal sinus cancer

The prognosis for patients with cancer of the paranasal sinuses (PNC) has been very poor, mainly due to a high rate of local recurrence. We report a series of 46 patients with PNC treated by craniofacial resection at the Royal Melbourne Hospital between November 1983 and June 1991. There has been no operative mortality or serious morbidity in these patients. The importance of a pericranial flap in the reconstruction of the floor of the anterior cranial fossa is emphasized. All patients have been followed to death or to the present time. There was a five year survival of 73% for squamous cell carcinoma and 83% for adenocarcinoma. This appears to represent a significant improvement in the long term results over conventional surgery and radiotherapy. The strong association between adenocarcinoma of the ethmoid sinuses and occupational exposure to hardwood dusts is borne out in our series. A history of prolonged wood dust exposure was given by all the 16 patients with adenocarcinoma and by 12 of the 25 patients with squamous cell carcinoma.