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Oral Cavity andNeck Dissection
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Fig. 130 Surgical bed
after selective neck
dissection I–III
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Fig. 131 Upper and
lower skin ap elevation
for modied radical
neck dissection
N. M. Nagarkar et al.
Oral Cavity andNeck Dissection
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Fig. 132 Modied
radical neck dissection
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Fig. 133 Modied
radical neck dissection
showing all structures
N. M. Nagarkar et al.
Fig. 134 Spinal accessory nerve in level V can be located
1cm superior to Erb’s point in the neck
Oral Cavity andNeck Dissection
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Fig. 135 Erb’s point in
the neck to localise the
spinal accessory nerve
155
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N. M. Nagarkar et al.
Fig. 136 Well-healed scar of modied Schobinger’s
incision
Fig. 137 Well-healed scar of apron incision with lateral
extension
Oral Cavity andNeck Dissection
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Fig. 138 Contracture band can occur if vertical drop is
not curved
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Nose and Paranasal Sinuses
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NitinMNagarkar, AmbeshSingh,
andRupaMehta
1 Introduction
Nose and paranasal malignancies refer to a wide
variety of cancers seen in the nose and adjacent
paranasal regions. But less than 1% of the malignant tumours identied in the head and neck area
are neoplasms. These tumours typically have mild
rst signs, making early detection challenging.
Because of this, the time between the onset of
symptoms and the nal diagnosis is often
6 months. Furthermore, these tumours have a
variety of histological presentations, making
diagnosis difcult. Nasal and paranasal malignancies are grouped by the World Health Organization
(WHO) into 44 unique histological categories,
which are roughly classied into epithelial and
non-epithelial groups [1], as given in Table1.
Information on surgery and histological distribution of benign sinonasal tract tumours from 1298
patients who had treatment at the university hospitals in Brescia and Varese [2] is described in Table2.
N. M. Nagarkar (*)
SRM Medical College Hospital and Research Centre,
SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu,
India
A. Singh
All India Institute of Medical Sciences,
Raipur, Chhattisgarh, India
R. Mehta
Department of ENT, All India Institute of Medical
Sciences, Raipur, Chhattisgarh, India
Table 1 Paranasal sinus malignancy histologic classication by the World Health Organization [1]
Epithelial malignancies
Squamous cell carcinoma
• Verrucous carcinoma
• Basaloid squamous cell carcinoma
• Papillary squamous cell carcinoma
• Spindle cell carcinoma
• Adenosquamous carcinoma
• Acantholytic squamous cell carcinoma
Lymphoepithelial carcinoma
Sinonasal undifferentiated carcinoma
Salivary gland-type carcinomas
• Adenoid cystic carcinoma
• Acinic cell carcinoma
• Mucoepidermoid carcinoma
• Clear cell carcinoma not otherwise specied
• Epithelial-myoepithelial carcinoma
• Myoepithelial carcinoma
• Carcinoma ex pleomorphic adenoma
• Polymorphous low-grade adenocarcinoma
Adenocarcinoma
• Intestinal-type adenocarcinoma
• Non-intestinal-type adenocarcinoma
Neuroendocrine tumours
• Typical carcinoid
• Atypical carcinoid
Small cell carcinoma, neuroendocrine type
Soft tissue malignancies
Fibrosarcoma
Malignant brous histiocytoma
Rhabdomyosarcoma
Leiomyosarcoma
Angiosarcoma
Malignant peripheral nerve sheath tumour
Bone and cartilage malignancies
(continued)
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
N. M. Nagarkar et al. (eds.), Atlas of Head Neck and Skull-base Surgery,
https://doi.org/10.1007/978-981-99-6132-0_8
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N. M. Nagarkar et al.
Table 1 (continued)
Chordoma
Chondrosarcoma
Mesenchymal chondrosarcoma
Osteosarcoma
Hematolymphoid malignancies
Langerhans cell histiocytosis
Extranodal natural killer/T-cell lymphoma
Diffuse large B-cell lymphoma
Extramedullary plasmacytoma
Extramedullary myeloid sarcoma
Histiocytic sarcoma
Neuroectodermal malignancies
Ewing sarcoma
Primitive neuroectodermal tumour
Olfactory neuroblastoma
Melanotic neuroectodermal tumour of infancy
Mucosal malignant melanoma
Germ cell malignancies
Teratoma with malignant transformation
Sinonasal teratocarcinosarcoma
Table 2 Benign tumours of the sinonasal tract by histology and surgical approach [2]
Surgical approach
Tumour histology
Inverted papilloma 592 75 12 679
Osteoma 115 54 13 182
Juvenile angiobroma 147 1 6 154
Lobular capillary hemangioma 68 0 0 68
Fibrous dysplasia 58 3 1 62
Schwannoma 16 3 0 19
Cavernous hemangioma 16 1 0 17
Ossifying broma 11 0 0 11
Hamartoma 46 0 0 46
Glioma 8 3 1 12
Pleomorphic adenoma 7 0 0 7
Miscellaneous 33 8 0 41
Total 1117 148 33 1298
Endoscopic Combined External Total
Accurately staging nose and sinus tumours is
difcult despite the advancements in endoscopy
and the widespread availability of modern imaging methods such as MRI and CT scans. Surgery
and radiation are the two main treatments; however, these treatments can cause signicant health
issues including facial deformation, difculty in
chewing and in some cases, blindness. Sinonasal
malignancies have a worse prognosis compared
to other head and neck region malignancies,
making quality of life considerations an important factor when assessing treatment options.
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