266 Acta Otorrinolaringol Esp. 2007;58(6):266-75 The annual incidence rate for paranasal sinus cancer is quite low in Europe at approximately 1 case a year per 100 000 inhabitants. The most frequent site is the maxillary sinus; in some countries such as Spain, however, carcinomas of the ethmoidal sinus complex are more prevalent. Squamous cell carcinoma is the most frequent histological type and adenocarcinoma is the one with the best prognosis. In general terms, the association of surgery and radiotherapy continues to be the optimal therapeutic option. The inclusion of an endoscopic endonasal approach for the treatment of these lesions must be considered in very selective cases. Most authors currently accept invasion of the fat and muscles of the orbital apex and infiltration of the conjunctiva and/or sclera as an absolute indication for orbital exenteration. Lymph node involvement at diagnosis or in the course of the disease is infrequent, so prophylactic lymph node treatment would therefore not be indicated. Key words: Carcinoma. Adenocarcinoma. Paranasal sinuses. Endoscopic surgery. Craniofacial resection. Radiotherapy. Chemotherapy. Revisión de los carcinomas de senos paranasales Los carcinomas de senos paranasales presentan una in- cidencia baja, aproximadamente un caso al año cada 100.000 habitantes entre la población europea. La localiza- ción más frecuente es el seno maxilar, aunque en algunos países como España los carcinomas de etmoides son el gru- po más numeroso. El tipo histológico más frecuente es el carcinoma escamoso, y el adenocarcinoma es la variante histológica con mejor pronóstico. En términos generales, la combinación de cirugía y radiote- rapia sigue siendo la modalidad terapéutica óptima. La in- clusión del abordaje endonasal endoscópico en el tratamien- to de estas lesiones debe considerarse en casos muy seleccionados. Actualmente, la mayoría de los autores acepta como indicaciones para llevar a cabo una exenteración orbi- taria la invasión de la grasa, la musculatura y el ápex orbita- rio y la infiltración de la conjuntiva y/o esclerótica. La afec- ción ganglionar en el momento del diagnóstico o durante el curso de la enfermedad es poco frecuente, lo que justificaría no tratar las cadenas ganglionares de manera profiláctica. Palabras clave: Carcinoma. Adenocarcinoma. Senos para- nasales. Cirugía endoscópica. Resección craneofacial. Ra- dioterapia. Quimioterapia. The authors have not indicated any conflict of interest. Correspondence: Dr. J.R. Gras Cabrerizo. Servicio de Otorrinolaringología. Hospital de la Santa Creu i Sant Pau. Avda. Mas Casanovas, 90. 08041 Barcelona. España. E-mail: jgras@hsp.santpau.es Received April 18, 2007. Accepted for publication April 26, 2007. INTRODUCTION Malignant tumours of the paranasal fossae and sinuses are lesions with characteristics distinguishing them from other head and neck tumours. They are infrequent, present wide histological variability, and are generally already at advanced stages at the moment of their diagnosis. All of this hinders the comparison of results and the ability to establish standardized treatment protocols. The goal of the present study is to review the most innovative aspects with regard to the main epidemiological and aetiological characteristics of these tumours, analyze the prognosis of patients according to localization and histological type, and finally assess the different therapeutic modalities and treatment outcomes. The review covers the most outstanding series published in the last 20 years by a search of Pub-Mediterranean using the following key words: carcinoma, adenocarcinoma, paranasal sinus, endoscopic surgery, craniofacial resection, radiotherapy, and chemotherapy, in order to obtain an up- to-date document for the management of these lesions. The histological types included have been solely those accepted by the current classification of malignant tumours according to the International Union Against Cancer (UICC) 1 : squamous carcinoma, adenocarcinoma, adenoid cystic carcinoma, and sinonasal undifferentiated carcinoma. Furthermore, following this classification system, maxillary and ethmoidal localizations have been included. Carcinomas of the frontal and sphenoid sinuses are very infrequent and are not reflected in the TNM system. Carcinomas of the nasal vestibule have in their turn been omitted as the behaviour of these tumours is closer to that of skin tumours than to ■ REVIEW ARTICLE Revision of Carcinomas in Paranasal Sinus Juan Ramón Gras Cabrerizo, a Adolfo Sarandeses García, b Joan Ramon Montserrat i Gili, a and César Orús Dotú a aServicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain bServicio de Otorrinolaringología, Complejo Hospitalario Juan Canalejo, A Coruña, Spain