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Operations for nasal and sinus cancer

The main aim of surgery is to remove the tumour along with the smallest possible amount of surrounding healthy tissue and bone. Your doctor will also try to prevent major changes to your vital functions such as breathing, chewing and swallowing. But in some cases the surgery will cause changes.

Surgery to remove nasal cavity cancer

It may be possible for the surgeon to just remove the tumour and some surrounding tissue. Or you may need to have part or all of your nose removed. If so, your surgeon will need to rebuild your nose using tissue taken from your face or another part of your body. Or they will use an artificial prosthesis to make a new nose.

Surgery to remove paranasal sinus cancer

The type of surgery you have depends on which sinuses are involved and the size of the tumour. This page describes the different operations to remove paranasal sinus cancer, including endoscopic surgery.

Surgery to remove your lymph nodes

This is called a neck dissection. Your surgeon may remove some or all of the lymph nodes on one side of your neck. There are several different types of neck dissection. Some people may have long term side effects after this type of surgery.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating nasal cancer section.

 

 

How the surgeon decides on treatment

The tests you have to diagnose your cancer will help your specialist decide if surgery is an option. The amount of surgery you need depends on the stage of your cancer. But your doctor may not always be able to tell you exactly what stage your cancer is until after surgery.

 

Surgery and the structure of the nasal cavity and sinuses

The structure (anatomy) of the nasal cavity and paranasal sinuses is very complex. There are many important nerves and blood vessels in and around this area. The nasal cavity and paranasal sinuses are also very near to organs such as your eyes, brain and mouth, which makes planning and doing the surgery difficult.

Your surgeon needs to consider how your face will look and how well it will all work after your surgery. The main aim is to remove the tumour along with the smallest possible amount of surrounding healthy tissue and bone. Your doctor will also try to prevent major changes to your vital functions such as breathing, chewing and swallowing. But in some cases the surgery will cause changes.

Unfortunately these cancers are often diagnosed when they are quite advanced. By then the cancer may have grown into the tissues surrounding the eyesocket (orbit), or even the eye itself. If this is the case, surgery can mean removing your eye or orbit for the best chance of cure. Doctors call the operation to remove the eye socket and eyeball orbital exenteration. Removing just the eyeball is called enucleation. This is highly specialist surgery carried out by doctors called ophthalmologists. There is more detailed information about eye cancer surgery in the eye cancer section.

Our living with nasal cavity and paranasal sinus cancer section has information about how surgery can change your

If the cancer has spread to your lymph nodes you will need an operation called a neck dissection. There is information about neck dissection in this section.

 

Surgery to remove nasal cavity cancer

Surgery to remove cancer of the nasal cavity may involve

Removal of the tumour and some surrounding tissue

Doctors call this operation a primary tumour resection or wide local excision. The surgeon removes the entire tumour and a border of normal tissue surrounding it. This border of healthy tissue is known as a clear margin. That means it is clear of cancer cells. The aim of the operation is to remove all visible signs of the cancer and any tissue around it that could contain cancer cells.

The tissue taken out is sent to the laboratory and very closely examined under a microscope. This is to make sure that there really is a border of healthy tissue (with no cancer cells) surrounding the tumour. 

If the tumour is in the wall that separates the two sides of the nasal cavity (the nasal septum), your surgeon may need to remove part or all of the septum. This is the wall of tissue you can feel between your nostrils.

Removal of part or all of your nose

If you have a tumour affecting the side of your nose, you will need to have that part of the nose removed. Doctors call this operation a partial rhinectomy. If the cancer has spread deep into the tissue of your nose, your surgeon may need to remove the whole of your nose. In both cases, your surgeon will need to rebuild your nose using tissue taken from your face or another part of your body. This may need further operations. Or they will use an artificial prosthesis to make a new nose.

This type of surgery is hard to hide. So it is likely that you will have to cope with changes in the way you look. Even a small change can have a big effect on how you see yourself. There is information on how to cope with these changes in your appearance in the living with nasal and paranasal sinus cancer section.

 

Surgery to remove paranasal sinus cancer

The type of surgery you have to remove this cancer varies. It depends on which sinuses are involved and the size of the tumour. You may have

Surgery to remove cancer in the ethmoid sinus (ethmoidectomy)

If you have a small tumour in the ethmoid sinus, your surgeon will cut through the skin at the top of the nose, next to your upper eyelid, and remove the cancer. This operation is called an external ethmoidectomy. To get to tumours inside the ethmoid sinuses, the surgeon will need to remove the bone on the inside of the nose and the tissues surrounding the eyeball (orbit).

Surgery to remove cancer in the maxillary sinus (maxillectomy)

If your cancer is in the maxillary sinus, you may have a maxillectomy. This means removing part or all of your upper jawbone.

The maxilla bone forms the upper jaw, the front part of the roof of the mouth, the sidewalls of the nasal cavity and part of the floor of the eye sockets. It helps shape the tissue around the eyeball (orbit), the nose and the roof of your mouth (hard palate).

There are several types of maxillectomies. Which one you have depends on exactly where the tumour is and how far it has spread into nearby tissue. You may need to have a

  • Partial maxillectomy
  • Total maxillectomy
  • Extended or radical maxillectomy

A partial maxillectomy means leaving one or more of the bony walls in place. If the tumour is affecting all of the maxilla the whole bone is removed. This is a total maxillectomy. If your cancer has spread into all the walls and also into nearby structures you will need to have a radical maxillectomy.

To perform these operations and get to the cancer your surgeon can do two things

  • Cut into the skin along the side of your nose, from the eyebrow or the eyelids down to (or through) the upper lip
  • Make a cut inside the mouth under the upper lip, which means you do not have to have a large scar on your face

Before your operation it is important to discuss with your surgeon the type of cut they will use. All these operations will leave a space in the roof of your mouth. Your surgeon may be able to fill this space using tissue taken from somewhere else on your head or another part of your body. Or a restorative dentist, or prosthodontist, can make an artificial structure, called a prosthesis, to fill this space. The missing piece is reconstructed with a piece of bone from another part of the body. A restorative dentist can fit a prosthesis with teeth to attach to the new jaw bone using dental implants. If you are going to have dental implants, you will probably have radiotherapy first, and possibly hyperbaric oxygen treatment. This involves sitting in a sealed room breathing oxygen at a higher than normal pressure. The idea is that this will help the bones and tissues to heal. But more research needs to be done to see if this really helps. A prosthesis will also help to make your facial appearance as normal as possible after major surgery.

These operations are major surgery and you will need time to recover and adjust to any changes. Try to be patient with yourself while you get better. Don’t expect too much too soon. There is information on how to cope with nasal and paranasal sinus cancer and the changes it may cause in the living with nasal and paranasal sinus cancer section.

Craniofacial resection

You may need a craniofacial resection if you have cancer in the

  • Ethmoid, frontal and sphenoid sinuses
  • Sphenoid sinuses alone

This is a very big operation and usually involves a team including one or more of these surgeons

  • Ear, nose and throat surgeon (otolaryngologist)
  • Jaw, face and neck surgeon (maxillofacial surgeon)
  • Brain surgeon (neurosurgeon)
  • Plastic surgeon

It includes removing parts of the base of the skull and the upper parts of the eye sockets. This is done through a scalp incision over the hairline. The lower part of the operation is similar to a maxillectomy. You will have to cope with some major changes in how you look. If you have a large area of tissue removed during your operation, you will need to have the area repaired. This can be done with

There is information about skin grafting and skin flaps in the section on surgery for mouth and oropharyngeal cancer. Your surgeon will talk it through with you in detail before the operation. Ask as many questions as you need to. It is very important that you feel supported and understand what is going to happen.

Flaps can be done using muscle and bone. This helps to fill the space where the tissue has been removed. The tissue for the flap can be taken from the hip (called a deep circumflex iliac flap) or the leg (called a fibular flap). The surgeon completely removes and repositions the piece of muscle, skin and bone, so this type of flap is called a free tissue flap. Because there is bone in the flap, it may be possible later to have a permanent implant fitted that joins to the new bone.

There is information on how to cope with changes in your appearance in the living with nasal cavity and paranasal sinus cancer section.

 

Endoscopic surgery to remove nasal cavity and paranasal sinus cancer

This type of surgery is not suitable for everyone. It will depend very much on the type of tumour you have and what other options are available. Doctors might use endoscopic surgery for people who

  • Have small tumours
  • Have a larger tumour but are not fit enough for a big operation

The main advantage of this surgery is that it causes less damage to the surrounding healthy tissue than the types of surgery mentioned above. It involves putting a long tube, with a camera and light inside it (an endoscope), up into the nose or sinus.

The surgeon uses surgical instruments or a laser through the endoscope to remove your cancer. People who have endoscopic surgery usually have radiotherapy as well.

 

Surgery to remove lymph nodes in your neck

If you need surgery to remove lymph nodes in your neck, your surgeon may recommend a

If you have a partial or selective neck dissection, you will have some of the lymph nodes in one side of your neck removed.

There are 3 types of modified radical neck dissection. With type 3 your surgeon will remove most of the lymph nodes between your jawbone and collarbone on one side of your neck. With the other 2 types your surgeon will also need to remove one or more of the following structures

  • A muscle at the side of your neck called the sternocleidomastoid
  • A nerve called the accessory nerve
  • A vein called the internal jugular vein

Diagram showing the muscle, nerve and blood vessel sometimes removed with a lymph node dissection of the neck

If you have a radical neck dissection, your surgeon will remove most of the nodes on one side of your neck, as well as all of the muscle at that side of your neck (the sternocleidomastoid muscle), the accessory nerve and the vein called the internal jugular vein.

These operations are vital for getting the best chance of stopping the cancer from spreading or coming back. But there are some side effects. These will depend on which of the following structures have been removed or disturbed during surgery

The accessory nerve controls shoulder movement, so if you have this removed, your shoulder will be stiffer and more difficult to move. If you have a partial or modified neck dissection, the weakness in your arm usually lasts only a few months. But if you have your accessory nerve removed, the damage is permanent. Your doctor will refer you to a physiotherapist, who will show you some exercises to help improve the movement in your neck and shoulder. It is important that you do these exercises regularly.

If you are still having problems with pain and movement a year after surgery, despite doing your exercises, your doctor may look into whether a further operation to reconstruct some of the muscles might help. But this will not be suitable for everyone.

You may also have some pain. Removing all of your sternocleidomastoid muscle will make your neck look thinner and sunken on that side.

Other side effects of neck dissection may be caused by damage to some of the nerves that supply the head and neck area. They include

  • Numbness in the ear on the same side as the operation
  • Loss of movement in the lower lip
  • Loss of movement on one side of the tongue
  • Loss of feeling on one side of the tongue
 

Surgery to relieve symptoms

You doctor may suggest surgery to relieve symptoms even if your cancer cannot be cured. This is called palliative surgery. This may give you a better quality of life for longer. You are most likely to need this type of treatment if your cancer is blocking any part of your nose and making it difficult for you to breathe.

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Updated: 5 July 2014