Malignant Tumors of the Sinuses Workup

  • Author: Christopher Klem, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 14, 2011
 

Laboratory Studies

As with other head and neck cancers, liver enzymes are usually obtained to assess for distant disease in addition to a chest radiograph or CT scan to evaluate for pulmonary metastasis.

In the case of a nasal cavity or paranasal sinus mass or erosion, an antineutrophil cytoplasmic antibody (ANCA) test for possible Wegener granulomatosis should be considered. This condition often mimics a neoplasm.

Consultation with multiple specialties should be considered because these tumors involve complex structures throughout the face and skull base. Consult neurosurgery as needed for skull base involvement and possible intracranial extension. Consult ophthalmology to document visual acuity, evaluation of any extra ocular motility disturbances, and proptosis. In addition, after surgery the ophthalmologist may be called upon to assist with treatment of epiphora or dry eye syndrome. Consult a dentist to evaluate for dental extraction in preparation for radiotherapy. Consult a prosthodontist if maxillectomy is expected, and consult speech pathology as needed.

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Imaging Studies

Imaging studies depend on the differential diagnosis. Plain radiography, CT scanning, and MRI all provide information. Each has its own advantages and limitations. With the ubiquitous nature of the acute and chronic inflammation disease in the sinonasal cavity and the complex anatomy of the sinonasal tract, these tumors are often difficult to diagnose and treat.

  • Magnetic resonance imaging (MRI) is vital in the establishing the presence or absence of factors that determine resectability such as orbital invasion, perineural spread, skull base invasion, intracranial extension, and invasion of the masticator and parapharyngeal spaces by tumor.[62] One of MRI’s greatest uses is in helping to demonstrate the distinction tumor and retaining secretions in the multiple sinus cavities.
  • Special emphasis should be placed on MRI evaluation of perineural invasion in adenoid cystic carcinoma because these can track down the nerve in over 60% of cases.[63] Esthesioneuroblastoma (ENB) on MRI often shows peritumoral cysts capping of the intracranial portion of the tumor, which is strongly suggestive of the diagnosis.[64]
  • CT scan has a higher accuracy at determining both bony remodeling and erosion of the skull base and sinuses. Osteolysis can often be observed with SCCA, metastatic disease, sarcoma, and SNUC. Boney remodeling is more often seen with salivary gland tumors, large cell lymphoma, melanoma, and ENB. In addition, chronic or acute inflammatory sinus disease may also cause boney remodeling.[62] Finally, CT scanning is slightly more accurate than MRI in demonstration of orbital invasion due to its ability to evaluate both the bony orbital wall and adjacent fat.

The authors’ opinion is that both CT scanning and MRI should be performed prior to surgical intervention to help assist in preliminary staging, surgical planning, and defining respectability in close consultation with the neuroradiologist. In addition, as most landmarks and normal anatomy after surgery are disrupted, recurrence is difficult to identify on imaging. Therefore, postoperative baseline imaging is recommended for comparison tumor surveillance. Apparent Diffusion Coefficient (ADC) mapping shows potential as an additional MRI tool to effectively differentiate benign/inflammatory lesions from malignant tumors in the sinonasal area.[65]

Positron emission tomography is still in its infancy, and little has been studied regarding its use in sinonasal malignancies (SNM).[66]

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Diagnostic Procedures

  • Biopsy is the only 100% accurate means of obtaining a tissue diagnosis.
  • Remember that the turbinates and the possibility of a juvenile angiofibroma may both lead to extensive bleeding. In addition, patients with midline nasal masses may include intranasal dermoids, gliomas, and meningoencephalocele with direct communication with the anterior cranial fossa. Should the surgeon suspect these neoplasms, proper imaging and other tests should be performed before biopsy.
  • A biopsy should be performed on highly suspicious vascular tumors in the OR under controlled conditions where bleeding can be more safely controlled.
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Histologic Findings

The important histologic features are discussed in detail for the individual neoplasms in the Clinical section.

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Staging

Staging of nasal cavity and paranasal sinus carcinomas is not as well established as for other head and neck tumors. Two generally accepted staging systems are currently in use. The Kadish staging system is used specifically for Esthesioneuroblastoma because this often involves the skull base and intracranial extension. For cancer of the maxillary sinus, the nasal cavity, and the ethmoid sinus, the American Joint Committee on Cancer (AJCC) has designated staging by TNM classification. No broadly accepted staging systems for frontal and sphenoid sinus cancer currently exist.[67]

Maxillary sinus

Primary tumor (T)

  • T1 - Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone
  • T2 - Tumor causing bone erosion or destruction including extension into the hard palate and/or the middle of the nasal meatus, except extension to the posterior wall of maxillary sinus and pterygoid plates
  • T3 - Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses
  • T4a - Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses
  • T4b - Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Nasal cavity and ethmoid sinus

Primary tumor (T)

  • T1 - Tumor restricted to any one subsite, with or without bony invasion
  • T2 - Tumor invading 2 subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion
  • T3 - Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate
  • T4a - Tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses
  • T4b - Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than (V2), nasopharynx, or clivus

Regional lymph nodes (N)

  • N1 - Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
  • N2 - Metastasis in a single ipsilateral lymph node, more than 3 cm but 6 cm or less in greatest dimension; or in multiple ipsilateral lymph nodes, 6 cm or less in greatest dimension; or in bilateral or contralateral lymph nodes, 6 cm or less in greatest dimension
  • N2a - Metastasis in a single ipsilateral lymph node more than 3 cm but 6 cm or less in greatest dimension
  • N2b - Metastasis in multiple ipsilateral lymph nodes, 6 cm or less in greatest dimension
  • N2c - Metastasis in bilateral or contralateral lymph nodes, 6 cm or less in greatest dimension
  • N3 - Metastasis in a lymph node more than 6 cm in greatest dimension

Kadish Staging for esthesioneuroblastoma [68]

  • Stage A: The tumor is limited to the nasal fossa.
  • Stage B: The tumor extends to the paranasal sinuses.
  • Stage C: The tumor extends beyond the paranasal sinuses.
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Contributor Information and Disclosures
Author

Christopher Klem, MD  Attending Surgeon, Chief, Head and Neck Oncologic Surgery, Microvascular Reconstructive Surgery, Assistant Chief, Otolaryngology–Head and Neck Surgery Service, Tripler Army Medical Center

Christopher Klem, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, and American Society for Reconstructive Microsurgery

Disclosure: Nothing to disclose.

Coauthor(s)

Jared M Theler, MD  Resident Physician in Otolaryngology-Head and Neck Surgery, Department of Surgery, Tripler Army Medical Center

Jared M Theler, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Specialty Editor Board

William M Lydiatt, MD  Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center

William M Lydiatt, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and Nebraska Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Karen H Calhoun, MD, FACS, FAAOA  Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Robin PE, Powell DJ, Stansbie JM. Carcinoma of the nasal cavity and paranasal sinuses: incidence and presentation of different histological types. Clin Otolaryngol Allied Sci. Dec 1979;4(6):431-56. [Medline].

  2. Bridger GP, Mendelsohn MS, Baldwin M, Smee R. Paranasal sinus cancer. Aust N Z J Surg. Apr 1991;61(4):290-4. [Medline].

  3. Golabek W, Drop A, Golabek E, Morshed K. Site of origin of paranasal sinus malignancies [in Polish]. Pol Merkuriusz Lek. Sep 2005;19(111):413-4. [Medline].

  4. Larsson LG, Martensson G. Carcinoma of the paranasal sinuses and the nasal cavities; a clinical study of 379 cases treated at Radiumhemmet and the Otolaryngologic Department of Karolinska Sjukhuset, 1940-1950. Acta radiol. Aug 1954;42(2):149-72. [Medline].

  5. Bornholdt J, Hansen J, Steiniche T, et al. K-ras mutations in sinonasal cancers in relation to wood dust exposure. BMC Cancer. Feb 20 2008;8:53. [Medline].

  6. Klintenberg C, Olofsson J, Hellquist H, Sokjer H. Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure. Cancer. Aug 1 1984;54(3):482-8. [Medline].

  7. Luce D, Gerin M, Leclerc A, Morcet JF, Brugere J, Goldberg M. Sinonasal cancer and occupational exposure to formaldehyde and other substances. Int J Cancer. Jan 21 1993;53(2):224-31. [Medline].

  8. Katori H, Nozawa A, Tsukuda M. Markers of malignant transformation of sinonasal inverted papilloma. Eur J Surg Oncol. Oct 2005;31(8):905-11. [Medline].

  9. McKay SP, Gregoire L, Lonardo F, Reidy P, Mathog RH, Lancaster WD. Human papillomavirus (HPV) transcripts in malignant inverted papilloma are from integrated HPV DNA. Laryngoscope. Aug 2005;115(8):1428-31. [Medline].

  10. Ott G, Kalla J, Ott MM, Muller-Hermelink HK. The Epstein-Barr virus in malignant non-Hodgkin's lymphoma of the upper aerodigestive tract. Diagn Mol Pathol. Jun 1997;6(3):134-9. [Medline].

  11. Katori H, Nozawa A, Tsukuda M. Histopathological parameters of recurrence and malignant transformation in sinonasal inverted papilloma. Acta Otolaryngol. Feb 2006;126(2):214-8. [Medline].

  12. Waitz G, Wigand ME. Results of endoscopic sinus surgery for the treatment of inverted papillomas. Laryngoscope. Aug 1992;102(8):917-22. [Medline].

  13. Krouse JH. Endoscopic treatment of inverted papilloma: safety and efficacy. Am J Otolaryngol. Mar-Apr 2001;22(2):87-99. [Medline].

  14. Busquets JM, Hwang PH. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis. Otolaryngol Head Neck Surg. Mar 2006;134(3):476-82. [Medline].

  15. Poetker DM, Toohill RJ, Loehrl TA, Smith TL. Endoscopic management of sinonasal tumors: a preliminary report. Am J Rhinol. May-Jun 2005;19(3):307-15. [Medline].

  16. Oikawa K, Furuta Y, Nakamaru Y, Oridate N, Fukuda S. Preoperative staging and surgical approaches for sinonasal inverted papilloma. Ann Otol Rhinol Laryngol. Sep 2007;116(9):674-80. [Medline].

  17. Cannady SB, Batra PS, Sautter NB, Roh HJ, Citardi MJ. New staging system for sinonasal inverted papilloma in the endoscopic era. Laryngoscope. Jul 2007;117(7):1283-7. [Medline].

  18. Tiwari R, Hardillo JA, Mehta D, et al. Squamous cell carcinoma of maxillary sinus. Head Neck. Mar 2000;22(2):164-9. [Medline].

  19. Batsakis JG, Rice DH, Solomon AR. The pathology of head and neck tumors: squamous and mucous-gland carcinomas of the nasal cavity, paranasal sinuses, and larynx, part 6. Head Neck Surg. Jul-Aug 1980;2(6):497-508. [Medline].

  20. Lavertu P, Roberts JK, Kraus DH, Levine HL, Wood BG, Medendorp SV. Squamous cell carcinoma of the paranasal sinuses: the Cleveland Clinic experience 1977-1986. Laryngoscope. Nov 1989;99(11):1130-6. [Medline].

  21. Lee CH, Hur DG, Roh HJ, et al. Survival rates of sinonasal squamous cell carcinoma with the new AJCC staging system. Arch Otolaryngol Head Neck Surg. Feb 2007;133(2):131-4. [Medline].

  22. Shipchandler TZ, Batra PS, Citardi MJ, Bolger WE, Lanza DC. Outcomes for endoscopic resection of sinonasal squamous cell carcinoma. Laryngoscope. Nov 2005;115(11):1983-7. [Medline].

  23. Weiss MD, deFries HO, Taxy JB, Braine H. Primary small cell carcinoma of the paranasal sinuses. Arch Otolaryngol. May 1983;109(5):341-3. [Medline].

  24. Huber PE, Debus J, Latz D, Zierhut D, Bischof M, Wannenmacher M. Radiotherapy for advanced adenoid cystic carcinoma: neutrons, photons or mixed beam?. Radiother Oncol. May 2001;59(2):161-7. [Medline].

  25. Douglas JG, Laramore GE, Austin-Seymour M, Koh WJ, Lindsley KL, Cho P. Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands. Int J Radiat Oncol Biol Phys. Aug 1 1996;36(1):87-93. [Medline].

  26. Laramore GE, Krall JM, Griffin TW, et al. Neutron versus photon irradiation for unresectable salivary gland tumors: final report of an RTOG-MRC randomized clinical trial. Radiation Therapy Oncology Group. Medical Research Council. Int J Radiat Oncol Biol Phys. Sep 30 1993;27(2):235-40. [Medline].

  27. Lupinetti AD, Roberts DB, Williams MD, et al. Sinonasal adenoid cystic carcinoma: the M. D. Anderson Cancer Center experience. Cancer. Dec 15 2007;110(12):2726-31. [Medline].

  28. Van Gerven L, Jorissen M, Nuyts S, Hermans R, Vander Poorten V. Long-term follow-up of 44 patients with adenocarcinoma of the nasal cavity and sinuses primarily treated with endoscopic resection followed by radiotherapy. Head Neck. Jun 2011;33(6):898-904. [Medline].

  29. Alessi DM, Trapp TK, Fu YS, Calcaterra TC. Nonsalivary sinonasal adenocarcinoma. Arch Otolaryngol Head Neck Surg. Sep 1988;114(9):996-9. [Medline].

  30. Heffner DK, Hyams VJ, Hauck KW, Lingeman C. Low-grade adenocarcinoma of the nasal cavity and paranasal sinuses. Cancer. Jul 15 1982;50(2):312-22. [Medline].

  31. Moran CA, Wenig BM, Mullick FG. Primary adenocarcinoma of the nasal cavity and paranasal sinuses. Ear Nose Throat J. Dec 1991;70(12):821-8. [Medline].

  32. Chang AE, Karnell LH, Menck HR. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. Oct 15 1998;83(8):1664-78. [Medline].

  33. Medina JE, Ferlito A, Pellitteri PK, Shaha AR, Khafif A, Devaney KO. Current management of mucosal melanoma of the head and neck. J Surg Oncol. Jun 2003;83(2):116-22. [Medline].

  34. Manolidis S, Donald P. Malignant Mucousal Melanoma of the Head and Neck. Head and Neck. 1997;80(8):1373-1386. [Medline].

  35. Dauer EH, Lewis JE, Rohlinger AL, Weaver AL, Olsen KD. Sinonasal melanoma: a clinicopathologic review of 61 cases. Otolaryngol Head Neck Surg. Mar 2008;138(3):347-52. [Medline].

  36. Billings KR, Wang MB, Sercarz JA, Fu YS. Clinical and pathologic distinction between primary and metastatic mucosal melanoma of the head and neck. Otolaryngol Head Neck Surg. Jun 1995;112(6):700-6. [Medline].

  37. Rosenthal DI, Barker JL Jr, El-Naggar AK, et al. Sinonasal malignancies with neuroendocrine differentiation: patterns of failure according to histologic phenotype. Cancer. Dec 1 2004;101(11):2567-73. [Medline].

  38. Hyams VJ. Tumors of the upper respiratory tract and ear. In: Atlas of Tumor Pathology. 2nd series. Fascicle 25. Washington D.C: Armed Forces Institute of Pathology; 1988:240-248.

  39. Kameya T, Shimosato Y, Adachi I, Abe K, Ebihara S, Ono I. Neuroendocrine carcinoma of the paranasal sinus: a morphological and endocrinological study. Cancer. Jan 15 1980;45(2):330-9. [Medline].

  40. Broich G, Pagliari A, Ottaviani F. Esthesioneuroblastoma: a general review of the cases published since the discovery of the tumour in 1924. Anticancer Res. Jul-Aug 1997;17(4A):2683-706. [Medline].

  41. Dulguerov P, Allal AS, Calcaterra TC. Esthesioneuroblastoma: a meta-analysis and review. Lancet Oncol. Nov 2001;2(11):683-90. [Medline].

  42. McElroy EA Jr, Buckner JC, Lewis JE. Chemotherapy for advanced esthesioneuroblastoma: the Mayo Clinic experience. Neurosurgery. May 1998;42(5):1023-7; discussion 1027-8. [Medline].

  43. Diaz EM Jr, Johnigan RH 3rd, Pero C, et al. Olfactory neuroblastoma: the 22-year experience at one comprehensive cancer center. Head Neck. Feb 2005;27(2):138-49. [Medline].

  44. Loy AH, Reibel JF, Read PW, et al. Esthesioneuroblastoma: continued follow-up of a single institution's experience. Arch Otolaryngol Head Neck Surg. Feb 2006;132(2):134-8. [Medline].

  45. Levine PA, Gallagher R, Cantrell RW. Esthesioneuroblastoma: reflections of a 21-year experience. Laryngoscope. Oct 1999;109(10):1539-43. [Medline].

  46. Rischin D, Porceddu S, Peters L, Martin J, Corry J, Weih L. Promising results with chemoradiation in patients with sinonasal undifferentiated carcinoma. Head Neck. May 2004;26(5):435-41. [Medline].

  47. Chen A, Daly M, El-Sayed I, et al. Patterns of Failure After Combined-Modality Approaches Incorporating Radiotherapy for Sinonasal Undifferentiated Carcinoma of the Head and Neck. Oncology Bio Phys Inter J. Radiation. 2007;70(2):338-343.

  48. Frierson HF Jr, Mills SE, Fechner RE, Taxy JB, Levine PA. Sinonasal undifferentiated carcinoma. An aggressive neoplasm derived from schneiderian epithelium and distinct from olfactory neuroblastoma. Am J Surg Pathol. Nov 1986;10(11):771-9. [Medline].

  49. Gallo O, Graziani P, Fini-Storchi O. Undifferentiated carcinoma of the nose and paranasal sinuses. An immunohistochemical and clinical study. Ear Nose Throat J. Sep 1993;72(9):588-90, 593-5. [Medline].

  50. Uchida D, Shirato H, Onimaru R, et al. Long-term results of ethmoid squamous cell or undifferentiated carcinoma treated with radiotherapy with or without surgery. Cancer J. Mar-Apr 2005;11(2):152-6. [Medline].

  51. Medina JE, Dichtel W, Luna MA. Verrucous-squamous carcinomas of the oral cavity. A clinicopathologic study of 104 cases. Arch Otolaryngol. Jul 1984;110(7):437-40. [Medline].

  52. Kapadia SB, Barnes L, Deutsch M. Non-Hodgkin's lymphoma of the nose and paranasal sinuses: a study of 17 cases. Head Neck Surg. Jul-Aug 1981;3(6):490-9. [Medline].

  53. Abbondanzo SL, Wenig BM. Non-Hodgkin's lymphoma of the sinonasal tract. A clinicopathologic and immunophenotypic study of 120 cases. Cancer. Mar 15 1995;75(6):1281-91. [Medline].

  54. Petrella T, Delfau-Larue MH, Caillot D, et al. Nasopharyngeal lymphomas: further evidence for a natural killer cell origin. Hum Pathol. Aug 1996;27(8):827-33. [Medline].

  55. Kimura Y, Tanaka S, Furukawa M. Angiosarcoma of the nasal cavity. J Laryngol Otol. Apr 1992;106(4):368-9. [Medline].

  56. Nappi O, Wick MR. Sarcomatoid neoplasms of the respiratory tract. Semin Diagn Pathol. May 1993;10(2):137-47. [Medline].

  57. Aust MR, Olsen KD, Lewis JE, et al. Angiosarcomas of the head and neck: clinical and pathologic characteristics. Ann Otol Rhinol Laryngol. Nov 1997;106(11):943-51. [Medline].

  58. Zevallos JP, Jain KS, Roberts D, El-Naggar A, Hanna EY, Kupferman ME. Sinonasal malignancies in children: A 10-year, single-institutional review. Laryngoscope. Jul 7 2011;[Medline].

  59. Yamasoba T, Kikuchi S, Sugasawa M, Higo R, Sasaki T. Occult follicular carcinoma metastasizing to the sinonasal tract. ORL J Otorhinolaryngol Relat Spec. Jul-Aug 1994;56(4):239-43. [Medline].

  60. Frigy AF. Metastatic hepatocellular carcinoma of the nasal cavity. Arch Otolaryngol. Sep 1984;110(9):624-7. [Medline].

  61. Cantù G, Bimbi G, Miceli R, et al. Lymph node metastases in malignant tumors of the paranasal sinuses: prognostic value and treatment. Arch Otolaryngol Head Neck Surg. Feb 2008;134(2):170-7. [Medline].

  62. Raghavan P, Phillips CD. Magnetic resonance imaging of sinonasal malignancies. Top Magn Reson Imaging. Aug 2007;18(4):259-67. [Medline].

  63. Yousem DM, Gad K, Tufano RP. Resectability issues with head and neck cancer. AJNR Am J Neuroradiol. Nov-Dec 2006;27(10):2024-36. [Medline].

  64. Schuster JJ, Phillips CD, Levine PA. MRI of olfactory neuroblastoma and appearance after craniofacial resection. AJNR Am J Neuroradiology. 1994;15:1169-1177.

  65. Sasaki M, Eida S, Sumi M, Nakamura T. Apparent diffusion coefficient mapping for sinonasal diseases: differentiation of benign and malignant lesions. AJNR Am J Neuroradiol. Jun 2011;32(6):1100-6. [Medline].

  66. Shojaku H, Fujisaka M, Yasumura S, et al. Positron emission tomography for predicting malignancy of sinonasal inverted papilloma. Clin Nucl Med. Apr 2007;32(4):275-8. [Medline].

  67. Nasal cavity and paranasal sinuses. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. 6th ed. Springer; 2002:59-67.

  68. Shojaku H, Fujisaka M, Yasumura S, Ishida M, Tsubota M, Nishida H. Positron emission tomography for predicting malignancy of sinonasal inverted papilloma. Clin Nucl Med. Apr 2007;32(4):275-8. [Medline].

  69. Suarez C. Management of the Orbit in Maligant Sinonasal Tumors. Head and Neck. Head and Neck;242-250.

  70. Medina JE, Ferlito A, Pellitteri PK, et al. Current management of mucosal melanoma of the head and neck. J Surg Oncol. Jun 2003;83(2):116-22. [Medline].

  71. Andrades P, Militsakh O, Hanasono MM, Rieger J, Rosenthal EL. Current strategies in reconstruction of maxillectomy defects. Arch Otolaryngol Head Neck Surg. Aug 2011;137(8):806-12. [Medline].

 
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