UNILATERAL NASAL OBSTRUCTION CAUSED BY SINO-NASAL NEOPLASTIC LESIONS

OBJECTIVE: To report pattern of unilateral nasal obstruction caused by sino-nasal neoplasms seen in two teaching hospitals in Sindh, Pakistan. DESIGN: A case series. SETTING: Ear, Nose and Throat (ENT) departments of Jinnah Postgraduate Medical Centre, Karachi and People's Medical College, Nawabshah between June 1995 to June 1998. METHODS: This study included 51 patients who presented with unilateral nasal obstruction persistantly for more than eight weeks. A proforma was designed to note the complaints, pinpoint the cause and look at the outcome of the treatment and prognosis. Thus, a detailed history of patients was undertaken through clinical examination, laboratory investigations e.g. blood profile, urine analysis, radiological (common and special) imaging, biopsy and histopathology. RESULTS: Neoplastic lesions of the nose and paranasal sinuses were found in 51 patients. This included 16 (31.37%) females and 35 (68.62%) males with an average age of 37 years. Benign lesions were 19 (37.25%) and 32 (62.75%) were malignant including single case of schwanoma, two cases of squamous papilloma and three patients with fibrous dysplasia while inverted papilloma was seen in six and nasopharyngeal angiofibroma in seven patients. Commonest malignant lesion was squamous cell carcinoma seen in 30 (58.82%) patients. Maxillary sinus was involved in 30 cases and 2 of them were arising from the ethmoid sinus and nasal cavity, and were found to be adenocarcinoma. For benign lesions, wide surgical approach was adopted and except one case of inverted papilloma which reccurred, rest were cured completely. Radical and oncologically sound surgical resection combined with radiation therapy remained the treatment of choice for all the malignant lesions. Local recurrence was seen in two cases. Only one patient died after 8 months due to distant metastasis. Two patients were lost to follow up after 25 months. CONCLUSION: Neoplastic lesions especially the benign tumors, promptly treated via wide surgical approach, mostly cure the lesion with negligible complication or no recurrence. Malignant lesions of the nose and sinuses are very often diagnosed in advanced T-stages (intracranial or intraorbital extentions) due to non-specific symptoms and have a poor overall prognosis even in the advances in surgical techniques, radiation therapy and new chemotherapeutic agents.