Delivered by Ingenta to: UCL LIBRARY IP: 5.101.219.127 On: Thu, 16 Jun 2016 20:14:31 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm The Role of Endoscopy in the Management of Nasal Neoplasia Jarrod J. Homer, F.R.C.S., Nick S. Jones, F.R.C.S., and Patrick J. Bradley, F.R.C.S. ABSTRACT Fiberoptic endoscopy has made a notable impact in rhinol- ogy over the last decade, mainly in the diagnosis and treatment of paranasal sinus inflammatory disease. The aim of this arti- cle is to review, discuss, and illustrate the role of endoscopy in the management of nasal neoplasia. We have reviewed our own experience and illustrate this with four cases. We discuss the role of endoscopy in the diagnosis. biopsy, resection, post- therapeutic surveillance, and palliation of these tumors. (American Journal of Rhinology 11, 41-47, 1997) M alignant nasal and paranasal sinus neoplasms are un- common, accounting for less than 1% of all malignan- cies and 3% of those of the head and neck. The initial present- ing symptoms are usually nonspecific, with the result that the majority of these tumors have often reached an advanced stage by the time of presentation. For these reasons, the cure rates from malignant neoplasia are poor. In a series of 102 patients, the overall 5-year survival rate for all malignant neoplasms of the nasal cavity was 49%, with most failures being due to "local recurrence" (or persistence) after treatment. I Fiberoptic endoscopy has become an essential part of the rhinological examination? Endoscopy allows a thorough and detailed examination of the nasal cavity. Endoscopic surgical techniques have transformed surgery for inflamma- tory nasal and paranasal sinus disease. With regard to nasal tumors, the endoscope can be used in diagnosis, biopsy, resection, palliation, and posttherapeutic surveillance. We have reviewed our experience of 215 previously untreated cases of nasal and paranasal sinus neoplasia seen over a 12-year period at Queens Medical Centre, Notting- ham (Table I). From the Department of Otorhinolaryngology - Head and Neck Surgery, Queens Medical Centre, Nottingham, England Address correspondence and reprint requests to Dr. Jarrod J. Homer, Department of Otorhinolaryngology - Head and Neck Surgery, Queens Medical Centre, Nottingham, England American Journal of Rhinology MATERIALS AND METHODS W e present a review of patients treated at Queens Medical Centre, Nottingham, from 1983 to 1995 with the diagnosis of a neoplasm of the nasal cavity, in- cluding the nasopharynx and paranasal sinuses. RESULTS A total of 215 patients with neoplasia of the nasal cavity were seen over the 12 year period. The breakdown of histological diagnoses is shown in Table I. Reviewing the use of the endoscope in detecting a nasal neoplasm, there were five cases where the lesions would have been missed unless the patient had been examined with an endoscope. Of these, two were small lesions of the postnasal space (1 lymphoma, 1 small cell carcinoma), and three were small inverted papilloma of the lateral nasal wall. In addition, there were two cases in which recurrent disease was detected endoscopically, which again would have oth- erwise been missed. These were a 3 mm recurrence of an olfactory neuroblastoma in the sphenoid sinus (Case Report 1), and a 3 mm recurrence of an adenoid cystic carcinoma in the roof of the anterior skull base. Both recurrences followed craniofacial resections of the primary neoplasia. Seven patients had an endoscopic resection for benign nasal neoplasia. In six of these, the technique used was a Wigand procedure (endoscopic fronto-spheno-ethmoidec- tomy).3 The other case was a small inverted papilloma localized on the anterior aspect of the middle turbinate that was resected endoscopically. Six of the seven patients had inverted papilloma, and after a minimum 22-month follow up, five remain disease-free (Table II). The case of the patient with recurrent disease is recorded in Case Report 3. The other patient had a mucopapillary cystadenoma of the lateral nasal wall and maxillary sinus. This was initially resected by a transpalatal medial maxillectomy, but recur- rent disease was resected endoscopically and he remains disease-free 18 months later. 41