P. after she experienced continual unilateral left facial pain. On biopsy of the left ethmoid sinus, there was shown to be an intestinal type adenocarcinoma. MRI imaging of the face/neck and CT of the thorax and abdomen displayed that the malignancy was confined to the left paranasal sinuses (Figure 1). Figure sellectchem 1 CT scans taken in 2006 after the patient’s initial referral to ENT. (a) CT scan showing a mass in the left nasal cavity, and (b) CT scan showing the mass in the left ethmoid sinus, The mass was initially thought to be an inverted papilloma, but following … Despite being offered a craniofacial resection (CFR), for cosmetic reasons, the patient elected for endoscopic removal of the tumour, which was carried out in August 2006 (Figure 2).

However, the patient continued to experience left-sided dull facial pain, and on biopsy a recurrence of the tumour was found (Figure 3). This was treated with a further endoscopic resection. Figure 2 CT scan taken in 2007 showing evidence of surgery in the patient’s left nasal cavity. The lesion has been removed, and the maxillary ostium is widened. Figure 3 (a) CT scan taken in 2007 showing soft tissue with bony wall destruction in the patient’s left posterior ethmoid sinus, which was a recurrence of the malignancy and treated with topical chemotherapy. (b) MRI scan taken in 2008 showing an area of high … Following this, regular biopsies were taken, and residual disease following the revision endoscopic resection was treated with 5-Fluorouracil topical chemotherapy.

Topical chemotherapy was again used in September 2008 to treat a recurrence of the tumour, located in the posterior ethmoidal sinus. The patient has continued to experience dull left-sided facial pain and due to this presented for biopsy. The biopsies show no evidence of neoplasia, and the patient will return for regular followup. 3. Discussion A review of the literature was carried out using databases such as Medline, Embase, and the Cochrane Library. The references of review articles were also used. 3.1. Craniofacial Resection Craniofacial resection (CFR) was first described in 1963 and has since been considered the standard treatment for malignancies involving the anterior skull base [2, 3]. Whilst CFR has been shown to have low recurrence rates, it is also associated with a long recovery and complication rates as high as 40% in some studies [2].

3.2. Is Endoscopic Resection a Viable Alternative? Endoscopic resection as a technique to remove malignant anterior skull base lesions has always been controversial, with many arguing that it is not safe. However, in the light of recent advances in both Carfilzomib technology and equipment, techniques are now available which allow this resection to be carried out safely. Transnasal endoscopic resection (TER) is a procedure that many now believe to be a reasonable alternative to CFR [2].