Surgical approach to tumors of the nasal cavity.

In the past there has been a general reluctance among rhinologists to remove the entire lateral nasal wall for fear of causing drastic disturbances of nasal physiology. It has been our observation that the physiological disturbances are fairly minimal if the patient, following surgery, uses nasal saline irrigations daily. Sometimes a nasal siphon or water pik is required to prevent crusting. It has also been noted that when the septum is removed, a chronic antritis on the contralateral side will usually occur. It has been our practice to do an antrostomy on the uninvolved side when the septum has been removed for any reason. Ophthalmologists have shown some reticence to having the entire bony support of the medial wall of the orbit and half the floor removed. This does necessitate transecting the lacrimal duct at its neck. We have, however, seen no trouble with epiphora following this provided the sac was allowed to drain in to the open nasal cavity. The trochlea is by necessity deprived of its support; however, the periostium seems to provide adequate support here and we have noticed no troublesome permanent problems with function of this muscle. The periorbita, which has been robbed of its osseous support, quickly epithelializes with nasal mucosa and becomes a part of the nasal cavity. Requirements for intranasal douching with saline have varied; however, we have had no problems with bothersome crusting following b.i.d. nasal irrigations. In cases where a small portion of the inferior turbinate could be preserved, there was always extreme hypertrophy of this remnant which usually brings the nasal physiology back to a nearly normal state which seldom requires any special care whatever. This paper presents primarily a method of approaching tumors of the sinonasal area, especially when there is difficulty in determining whether the lesion arises from the septum or lateral wall of the nose.