Malignancies of the Nasal Vestibule : A New Perspective on Classification, Staging, and Treatment

This book provides up-to-date information on nasal vestibule malignancies, outlining the specific clinical history and pattern of spread. It also describes the flaws in TNM staging, which can be attirbuted to factors ranging from the anatomy to the definition of the main prognostic parameters. Nasal vestibule malignancies are associated with a peculiar oncological history, but there are also clear issues related to the reconstructive phase following ablative surgery due to the anatomic peculiarities. Such issues deeply impact the cosmetic and functional results, and hence the quality of life of surviving patients. Additionally, the book describes novel evidence on treatment outcomes for these malignancies in terms of both oncological and functional results. It proposes a new standard based on interstitial HDR brachytherapy for the primary lesion and on surgery for regional metastases. The book appeals to a wide readership, ranging from otolaryngologists, to radiation and clinical oncologists, dermatologists, plastic surgeons and maxillo-facial surgeons. Foreword Preface Contents About the Editor 1: Anatomy of the Nose Vestibule 1.1 Introduction 1.2 Osteocartilaginous Framework and Nose Vestibule 1.3 Cartilaginous Pyramid (Nose Vestibule Framework) 1.4 Nasal Septum 1.5 Muscles and Ligaments 1.6 Conclusions References 2: Histology of Nose Vestibule Malignancies 2.1 Normal Histology 2.2 Malignancies of the Nasal Vestibule 2.2.1 Squamous Cell Carcinoma 2.2.1.1 Keratinizing Squamous Cell Carcinoma of Nasal Vestibule 2.2.1.2 Non-Keratinizing Squamous Cell Carcinoma of Nasal Vestibule Differential Diagnoses 2.2.1.3 Basaloid Squamous Cell Carcinoma 2.2.1.4 Spindle Cell Carcinoma 2.2.1.5 Verrucous Carcinoma 2.2.1.6 Adenosquamous Carcinoma 2.2.2 Malignant Melanoma 2.2.3 Merkel Cell Carcinoma 2.2.4 Adenocarcinoma 2.2.4.1 Adenoidcystic Carcinoma 2.2.4.2 Mucoepidermoid Carcinoma 2.2.4.3 Acinic Cell Carcinoma 2.2.5 Mesenchymal Tumors 2.2.6 Hematolymphoid Tumors 2.2.6.1 Diffuse Large B-Cell Lymphoma 2.2.7 Rare Entities 2.2.7.1 Sinonasal Undifferentiated Carcinoma (SNUC) 2.2.7.2 NUT Carcinoma References 3: Peculiar Patterns of Spread of Nose Vestibule Malignancies 3.1 Introduction 3.2 Determinants of Tumor Spread from the Nose Vestibule 3.3 Typical Patterns of Spread from the Lateral Wall 3.4 Typical Patterns of Spread from the Medial Wall 3.5 Typical Patterns of Spread from the Inferior Wall References 4: Current Staging Systems for Nose Vestibule Malignancies 4.1 Introduction 4.1.1 Principles of TNM Classification 4.1.2 Current UICC/AJCC TNM Classification for Nose and Paranasal Sinuses Malignancies 4.1.3 Evolution of UICC/AJCC TNM of Nose and Paranasal Sinus 4.1.4 Alternative Staging Systems for Nose Vestibule Malignancies References 5: A Proposal for a Consistent Classification of Nasal Vestibule Carcinomas 5.1 Definition of the Nose Vestibule 5.2 Misdiagnosis for Skin Primary 5.3 General Issues in TNM Staging 5.4 Rethinking Classification and Staging of NV Malignancies References 6: Acknowledged Therapeutic Options in Nose Vestibule Malignancies 6.1 Introduction 6.2 Surgery 6.3 Radiotherapy References 7: Surgery in Nose Vestibule Malignancies: The Ablative Phase 7.1 Introduction 7.2 Surgery 7.3 Resection References 8: Surgery in Nose Vestibule Malignancies: The Reconstructive Phase 8.1 Introduction 8.2 Principles of Reconstruction 8.3 Limited-Size Defects with Skin Preservation or Minimal Skin Involvement 8.3.1 Healing by Secondary Intention 8.3.2 Skin Grafts 8.4 Reconstruction in Partial Ablation 8.4.1 Internal Lining 8.4.2 Skeletal Support 8.4.3 Cutaneous Reconstruction 8.4.3.1 Melolabial Flap 8.4.3.2 Forehead Flap 8.4.4 Additional Face Units’ Defects 8.4.5 Reconstruction in Total and Extended Total Ablation 8.4.5.1 Prosthesis 8.4.5.2 Surgical Reconstruction Internal Lining and Skeletal Support in Total Nasal Reconstruction Cutaneous Reconstruction Specific Considerations in Total and Extended Total Nasal Reconstruction References 9: Prostheses for Cosmetic and Functional Restoration After Ablative Surgery for Nose Vestibule Malignancies 9.1 A Brief History, Rationale, and Indications 9.2 Current Standards 9.3 Manufacturing 9.3.1 Traditional Manufacturing 9.3.2 Computer-Aided Manufacturing 9.3.3 Prototypting 9.3.4 Digital Library 9.3.5 Materials and Techniques 9.3.6 Future Aspects 9.3.7 Examples 9.4 Retention 9.5 Complications 9.6 Reported Functional, Cosmetic Results, and QOL 9.7 Future Perspectives References 10: External Beam Radiotherapy for Nose Vestibule Malignancies 10.1 Introduction 10.1.1 Potential Predictive Factors, Data to Guide Treatment Recommendation 10.1.2 EBRT 10.1.2.1 Early Stage (T1–T2 According to Wang) 10.1.2.2 Advanced Stage (T3 According to WANG or More Than 4 cm) 10.2 Role of Chemotherapy 10.3 EBRT Techniques 10.3.1 Positioning and Immobilization 10.3.1.1 3D Conformal Radiotherapy 10.3.1.2 IMRT/VMAT 10.3.2 Definition of Target Volume 10.3.3 Dose 10.3.4 Side Effects and Cosmetic Results 10.4 Conclusions References 11: Interventional Radiotherapy (Brachytherapy) for the Treatment of Primary Lesions in Nasal Vestibule Malignancies 11.1 Background 11.2 History of Interventional Radiotherapy 11.3 IRT Techniques 11.3.1 Mold Technique/Superficial Application 11.3.1.1 Contact Mold Preparation 11.3.2 Interstitial Implantation Technique 11.4 Outcomes of IRT References 12: Brachytherapy for Nose Vestibule Malignancies: Functional Results 12.1 Physiology of the Nose and Paranasal Sinuses 12.1.1 Ventilatory Function 12.1.2 Air-Conditioning Function 12.1.3 Defense Function 12.1.4 Olfactory Function 12.1.5 Resonance Function 12.1.6 Impact of Irradiation on Nasal Function 12.2 Personal Experience 12.3 Conclusion: Brachytherapy (IRT) Preserves Nose Function References 13: A Novel Approach to Interventional Radiotherapy (Brachytherapy) in Nose Vestibule. From Paris System Rules to Anatomic Implantation 13.1 General Considerations 13.2 Oncological Considerations 13.3 Functional/Cosmetic Considerations 13.4 Specific Considerations About Interstitial, Intracavitary, or Surface Dose Delivery 13.5 Anesthesiology and Operating Theater Setting References 14: Nasal Vestibule Cancer: Management of the Regional Lymph Nodes 14.1 Background 14.2 Anatomy and Lymphatic Drainage 14.3 Incidence 14.4 Evaluation of the Regional Lymph Node Basins 14.5 Treatment of the Neck 14.5.1 Elective Neck Management 14.5.2 Therapeutic Neck Management 14.6 Survival Outcomes 14.7 Follow-Up and Surveillance 14.8 Conclusion References 15: Malignancies of the Nose Vestibule: Salvage Strategies 15.1 Introduction 15.2 Regional Recurrence 15.3 Local Recurrence 15.3.1 Preoperative Evaluation 15.3.2 Surgical Planning 15.3.3 Reconstructive Options References 16: Setting New Standards for Nasal Vestibule Malignancies 16.1 Setting New Standards for Classification and Staging 16.1.1 Rethinking the Classification and Staging of Nasal Vestibule Malignancies 16.2 Current Treatment Options for Nasal Vestibule SCCs: Evidence Supporting Brachytherapy as the New Standard for Treatment of the Primary Lesion 16.2.1 Oncological Outcomes 16.2.2 Cosmetic Outcomes 16.2.3 Functional Outcomes 16.2.4 The New Standard 16.3 Implantation Technique for Nasal Vestibule Primaries 16.4 Conclusions: Toward New Standards References