What Are the Most Common Nasal Symptoms?

There are many types of nasal tumors. The symptoms of papilloma of the nasal cavity and sinuses are nasal congestion, and the surface of new organisms in the nose is papillary. However, there is a type called "inverted papilloma", because the nipple grows deep into the mucosa, the surface is smooth, and it is easy to mix with nasal polyps, and it needs to be identified by pathological section. Papilloma is easy to recur after resection and may be cancerous.

There are many types of nasal tumors. The symptoms of papilloma of the nasal cavity and sinuses are nasal congestion, and the surface of new organisms in the nose is papillary. However, there is a type called "inverted papilloma", because the nipple grows deep into the mucosa, the surface is smooth, and it is easy to mix with nasal polyps, and it needs to be identified by pathological section. Papilloma is easy to recur after resection and may be cancerous.

Hemangiomas are mainly manifested by repeated nosebleeds, sometimes with a large amount of bleeding. Malignant tumors are more common in people over 40 years of age, and young people also occur. The anatomical positions of the nasal cavity and sinuses are hidden, and they are near the orbit and skull base. Early detection is difficult, and the early symptoms are mainly unilateral and long-term snot with blood. With the growth of the cancer, nasal congestion becomes worse; when the cancer has necrosis or secondary infection, the nose has a special fishy smell.

Chinese name

Nasal tumor

Department

Oncology

Clinical manifestations of nasal tumors

Ill headaches are also common. Pain of the upper teeth and numbness of the cheeks of unknown origin on the ipsilateral side are one of the important early symptoms of maxillary sinus cancer. When the first bicuspids, the first and second molars are painful, but no obvious lesions can be found in the teeth themselves. If the pain is not relieved after tooth extraction, further examination is required.

Because the cancer infiltrates and develops continuously into surrounding tissues, it can cause a series of different symptoms, such as eyeball displacement and difficulty in opening mouth, according to the different parts it grows on. Advanced cancer can destroy bone and penetrate soft tissues to the face or the top of the mouth. When the cancer metastases, the enlarged lymph nodes can be felt under the jaw, and the texture is hard, and it is generally fixed without pressure. X-ray film pair

Understanding the extent of tumor invasion is helpful. The pathological examination of the local mass is necessary to determine the nature of the tumor and determine the treatment plan.

Nasal tumor surgery

Clinically, benign and malignant tumors of the nose and sinuses are common. As the nose and sinuses are closely related to the anterior cranial fossa, orbital, lacrimal, nasopharynx, pterygopalatine fossa, and oral cavity, nasal and sinus tumors can often invade these parts; partly from the anterior cranial fossa, nasopharynx, orbital Tumors in other parts often involve the nose; tumors that originate at the junctions of the nose, skull, nose, mouth, and nose orbit can develop in both directions, causing complications in the nasal cavity and sinuses. With the development of microsurgery technology, sinus endoscopy technology and imaging diagnosis technology, the knowledge and diagnostic level of nasal tumors have been further improved, thereby broadening the scope of indications for nasal surgery. In selecting surgical approaches and determining surgical resection Great progress has been made in terms of scope, postoperative management, and prevention of complications. Combined with the development of new technologies in the fields of laser, radio frequency, microwave and the concept of minimally invasive surgery, the perioperative period of traditional nasal and sinus tumors has been improved, and the diagnosis and surgical exploration of tumors at the junction have been emphasized. The preservation and restoration of the normal physiological functions of the sinuses and sinuses have made nasal tumor surgery an all-round development and increasingly become an important field of otolaryngology, head and neck surgery.

I. Indications for surgery and principles of lesion resection

(I) Indications for surgery

benign tumors of the nasal cavity and sinuses.

Malignant tumors confined to the nasal cavity and sinuses, without distant organ metastasis.

Malignant tumors of the nose and sinuses invade the surrounding bone or skull base bone, invade the dura mater or brain parenchyma, and the scope is limited to the anterior cranial fossa without distant organ metastasis.

(B) the principle of lesion resection

Try to completely remove the tumor at one time under direct vision. Small benign tumors can be removed using endoscope and laser, radio frequency, microwave and other techniques.

Surgery is performed in aseptic order followed by bacterial order. If intracranial tumors of the nose and sinuses are violated, surgery should be performed intracranially and extracranially.

Those affected by nearby organs and tissues are excised together with the affected area, and then repaired. If the nose and sinus cancer destroy the skull base bone, invade the intracranial dura mater or damage the brain parenchyma, they can also be removed.

Preparation before surgery

Consider a physical examination to understand the extent of the lesion, the general condition, and the ability to tolerate surgery.

Necessary laboratory inspection to understand the functional status of each important organ. Such as ECG examination, liver and kidney function tests, coagulation function tests.

Imaging examination

X-ray, CT or MRI examination: to understand the extent of the lesion and determine the extent of surrounding bone destruction. Such as the sieve plate, ethmoid sinus, maxillary sinus, sphenoid sinus, sphenoid bone, rock bone, pterygium, etc., whether there is damage and the extent of damage and adjacent gap invasion. CT and MRI can clearly understand the overall picture of the tumor and its relationship with surrounding structures, and are of great value in assessing the scope of surgical resection and formulating surgical procedures. Digital subtraction angiography (DSA): Angiography can understand the blood supply of tumors, the main blood supply vessels, venous return and its relationship with intracranial blood vessels. Embolization of the main blood supply arteries can be performed to reduce intraoperative bleeding.

Malignant tumors need to be clear of distant metastasis. Such as chest X-rays to understand the presence of double lung and mediastinal metastases, bone X-rays to understand the presence of bone metastases, liver and kidney B-ultrasound to exclude liver and liver. Renal metastasis, etc.

Pathological examination In principle, a pathological examination should be performed before surgery to confirm the diagnosis. However, for patients with special space-occupying lesions, inability to perform biopsy before surgery, or multiple pre-surgical medical examinations that are highly suspected of malignant tumors, rapid frozen biopsy should be performed during surgery.

Prepare blood according to the nature of the lesion, the scope of the operation, the patient's physical condition, the possible duration of the operation, and the estimated blood loss.

Application of antibiotics before surgery Some antibiotics should be used before surgery. Such as the cranial side combined surgery, antibiotics should be injected intravenously one day before surgery, intraoperative should be strengthened again, antibiotics in the nasal cavity, those with more nasal secretions, while nasal irrigation.

For those with increased intracranial pressure, 20% mannitol should be used first to reduce dehydration to reduce cranial pressure, improve the general situation of patients, and increase the patient's tolerance to surgery.

Choice of surgical approach and operation method

The choice of surgical approach and technique is mainly based on the nature of the lesion, the location and extent of the lesion invasion.

(I) Principle of Operational Choice

The operation method can ensure that the surgeon completely removes the tumor gradually or shallowly from shallow to deep, from the outside to the inside, under the direct view.

Try to avoid damage to the dura, brain tissue, engineering, , , , V, and other cerebral nerves, arteries and venous blood vessels during surgery. If the damage is unavoidable, the damage should be minimized as much as possible, and the operation method should also satisfy the repair of various structural wounds in the same surgical field.

Can effectively control arterial and venous bleeding that may occur during surgery.

Conducive to repair and plastic tissue damage.

(B) the main approach

Sacral rhinotomy is an ideal approach to remove tumors in the nasal cavity, medial maxillary sinus, and ethmoid sinus. It can also expand the lesions of the ethmoid sinus, frontal sinus, and sphenoid sinus in the treated group. Do selective resection. The advantage of this procedure is that the visual field is wide, which is conducive to the radical resection of the tumor, and the disadvantage is that scars are left on the face.

Plantar median overturn surgery This method can fully expose the bilateral anterior maxillary wall and nasal cavity structure, and it can be very close to the anatomical parts such as the nasal cavity, nasal septum, maxillary sinus, ethmoid sinus, sphenoid sinus, nasopharynx, and slope. After the tumor, no scar remains on the face.

Nasal endoscopic surgery Most people think that for nasal or nasal sphenoid sinus, ethmoid sinus, and limited maxillary sinus lesions, nasal endoscopic surgery can be used, more extensive lesions should use other surgical methods or nasal endoscopy and other procedures Combination. The advantages of this method are that it can accurately determine the tumor site, retain normal mucosa and bone structure, and avoid facial scars. The disadvantage is that it is not conducive to hemostasis and is one-handed operation.

Tumor resection with zygomatic cranial approach This method is suitable for resection of tumors that damage the bone of the anterior skull base, invade the dura mater or invade the brain tissue, and can remove both intracranial and extracranial tumors at one time. According to the scope of the tumor, the anterior cranial fossa frontal flap craniotomy can be performed to remove the dura mater and craniocerebral tissue invaded by the tumor, and then the enlarged nasal incision can be used to remove the tumor in the nasal cavity and sinuses. At the same time, it can be repaired or damaged Defects of the dura mater and skull base. There are three common approaches: the suprafrontal approach, the frontal sinus approach, and the transorbital approach.

Sacral combined resection of the suprafrontal approach: a nasal cavity and sinus surgery approach plus an intrafrontal incision. The craniotomy was performed during surgery, the frontal flap was made, the anterior skull base was exposed under direct vision, and the scope of invasion of intracranial lesions was determined. The tumor was removed in one piece at a safe margin to reduce the residual lesions and damage to intracranial blood vessels and nerves. For tumors in the nose and maxillofacial region, the resection area should be determined according to the extent of local lesions. If necessary, the affected dura mater can be resected and repaired in one stage. When the skull base bone defect is large, it can also be repaired in one stage. Surgery has a great impact on the brain tissue. Postoperatively, according to the requirements of intracranial surgery, pay attention to changes in intracranial pressure, prevent cerebral edema, and give dehydrating agents in time;

Sufficient antibiotics were applied before, during and after surgery.

Sacral-frontal sinus approach with craniofacial resection: The upper end of the conventional incision is extended through the human hairline at the forehead, the affected frontal tissue flap is opened, the frontal sinus is opened, and the anterior skull is exposed directly At the end, the entire lesion is removed, and the surgery has less interference with brain tissue. However, this method is not suitable for patients with a wide range of skull base invasion and those with poor or undeveloped frontal sinuses.

(3) Combined craniofacial resection of the superior orbital approach: Make a forehead flap in the frontal hairline, fold the flap forward to the upper orbital margin, separate the orbital periosteum into the orbit, and make the frontal bone and the orbital top respectively. Bone flap into the anterior skull base. The advantages of this approach are: better exposure of skull base lesions, less traction of brain tissue, excellent exposure to the ethmoid sinus, sphenoid sinus, maxillary sinus, and upper posterior orbit. Because the bone flap includes the upper orbital margin and part of the orbital apex, Make a nasal incision for good cosmetic results. However, supraorbital nerves and arteries may be damaged.

Fourth, postoperative management and major complications

(I) Postoperative management

Special care after surgery should pay special attention to consciousness, breathing, blood pressure, pulse and electrolyte balance.

Apply a sufficient amount of antibiotics that can penetrate the blood-brain barrier.

Sacral craniotomy patients should pay attention to intracranial pressure and give dehydrating agent if necessary.

Keep the epidural space and subcutaneous drainage tube unobstructed. The nasal stuffing is withdrawn 7 to 10 days after surgery. If there is an implant, be careful not to disturb it. If there is scab on the top of the nasal cavity, let it fall off by itself.

(B) the main complications

Postoperative hemorrhage is mostly related to incomplete hemostasis and loose packing in the operation cavity. Surgical procedures should be lightweight, hemostasis should be thorough, and more can be avoided.

The surgical cavity or intracranial and intraorbital infections should be kept in a sterile state to reduce the chance of infection. The operation should be intracranial and extracranial. Dural rupture should be repaired carefully to ensure tight sealing to prevent the occurrence of cerebrospinal fluid nasal leakage and intracranial infection.

Cerebrospinal fluid nasal leakage is mostly caused by inadequate repair of the dura mater. Therefore, after repairing the dura mater with free fascia, it should be covered with a larger pedicled fascia, and pay attention to suture fixation and compression, which can be avoided. Even if there is a slight leakage early in the postoperative period, most of them can heal themselves.

Secondary encephalocele in the skull defect area should be performed intracranial repair for those with larger bone defect, which can be done with the frontal bone plate, rib cartilage, bone cement or artificial biological materials.

Olfaction disorder is an unavoidable complication and cannot be recovered. Therefore, patients should be explained before surgery.

Nasal tumors related knowledge

Hemangiomas are mainly manifested by repeated nosebleeds, sometimes with a large amount of bleeding. Malignant tumors are more common in people over 40 years of age, but they also occur in young people. Because the anatomical position of the nasal cavity and sinuses is hidden, it is near the orbit and skull base.

Ill headaches are also common. Pain of the upper teeth and numbness of the cheeks of unknown origin on the ipsilateral side are one of the important early symptoms of maxillary sinus cancer. When the first bicuspids, the first and second molars are painful, but no obvious lesions can be found in the teeth themselves. If the pain is not relieved after tooth extraction, further examination is required.

Because the cancer infiltrates and develops continuously into surrounding tissues, it can cause a series of different symptoms, such as eyeball displacement and difficulty in opening mouth, according to the different parts it grows on. Advanced cancer can destroy bone and penetrate soft tissues to the face or the top of the mouth. When the cancer metastases, the enlarged lymph nodes can be felt under the jaw, and the texture is hard, and it is generally fixed without pressure. X-ray film pair

Understanding the extent of tumor invasion is helpful. The pathological examination of the local mass is necessary to determine the nature of the tumor and determine the treatment plan.