Clinical Photo of The Week: Vol3,No9

The following case was presented in vol3,No9 of otorhinolaryngology newsletter:
A 41-year old male presented with recurrent epistaxis and persistent sero-sanguinous rhinorrhoea following radiotherapy treatment for a lesion biopsied from his right gingivo-buccal sulcus, and histologically diagnosed as squamous cell carcinoma. Examination revealed the sign demonstrated in this picture and negative orbital or neurological signs. CT-Sinuses showed soft tissue opacity completely filling right maxillary sinus with extension to right ethmoidal air cells, nasopharynx, right nasal cavity and erosion of anterior wall of right maxilla. An opaque ipsilateral sphenoid sinus was also found. No orbital extension was found and ipsilateral pterygoid plate was free. Vision was good in both eyes.

The Best Management Option? Well, On account of nasopharyngeal involvement, some authorities advocate irresectability. However, on account of the young age of this patient, and the fact that vision was excellent both eyes, we offered him right extended Denker's approach combined with right infrastructure maxillectomy. Cheeck flap margin was free, nasal septal margin was involved. We have followed him up for 4 months now with good healing and no reccurence so far.