Surgical Considerations in the Management of Tumours of the Nose and Paranasal Sinuses in a Northern Nigerian Teaching Hospital
BACKGROUND: Tumours of the nose and paranasal sinuses in sub-Saharan Africa are generally characterised by late presentation posing management challenges to the otorhinolaryngologists in the sub-region. OBJECTIVES: To appraise surgical considerations in the management of tumours of the nose and paranasal sinuses in a developing nation from the experiences of an Ear, Nose, and Throat Department of a Nigerian Teaching Hospital. METHODS: This was a chart review of patients with tumours of the nose and paranasal sinuses who underwent various surgical operations over a period of four and a half years.The patients were referred by other physicians or health care workers. They were assessed clinically, backed by laboratory and radiological investigations. RESULTS: A total number of 55 patients underwent 64 surgical operations. There were 31 (56.4%) males and 24 (43.6%) females, giving a male to female ratio of 1.3:1. They were aged between four years and 70 years. In 46(83.6%) patients the tumours had extended beyond the nasal cavity or one sinus cavity to contiguous structures. The surgical operations carried out were lateral rhinotomy in 37(57.8%), intranasal clearance and intranasal antrostomy in 16(25%), total maxillectomy in seven(11%), and anterior craniofacial resection in two (3.1%) patients. The histological examination showed that 43 (78.2%) cases were benign, while 12 (21.8%) cases were malignant. These malignant cases needed radiotherapy and chemotherapy. CONCLUSION: Majority of the cases were characterised by late presentation, requiring surgical approaches such as lateral rhinotomy, total maxillectomy or craniofacial resection depending on the extent of the tumour. Poverty, ignorance, inadequate funding and administration challenges of health resources are factors militating against proper clinical management of tumours of the nose and paranasal sinuses in developing nations. Provision of free medical care and modern facilities for early diagnosis, treatment, and health education are needed to reverse the trend.
WAJM 2009; 28(6): 371–375.
Keywords: Lateral rhinotomy, maxillectomy, craniofacial resection, otorhinolaryngology, Northern Nigeria, Nose, paranasal sinuses.