9. Give us the TNM staging of sinonasal cancer.

Staging of nasal cavity and paranasal sinus carcinomas is not as well established as for other
head and neck tumors. For cancer of the nasal cavity and the ethmoid sinus, the American Joint
Committee on Cancer (AJCC) has designated a staging system using the TNM classification.[46]
This staging system differentiates resectable (T4a) from unresectable (T4b) tumors by
recognizing recent surgical advances and limitations, as follows:

TX: Primary tumor cannot be assessed

T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor restricted to any one subsite, with or without bony invasion
T2: Tumor invading two subsites in a single region or extending to involve an adjacent
region within the nasoethmoidal complex, with or without bony invasion
T3: Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate,
or cribriform plate
T4a: Tumor invades any of the following: anterior orbital contents, skin of nose or cheek,
minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses
T4b: Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa,
cranial nerves other than (V2), nasopharynx, or clivus

The AJCC also recommends a different system for soft-tissue sarcomas. This system includes a
histologic grading system that differs from the system used for epithelial tumors. Grading is
considered the most significant prognostic factor in patients with mesenchymal tumors and is
based on the number of mitoses, degree of cellularity, amount of stroma, degree of maturation,
nuclear pleomorphism, and presence or absence of necrosis.
10. List the known risk factors for sinonasal cancer.

The annual incidence of nasal tumors in the United States is estimated to be less than 1 in
100,000 people per year. These tumors occur most commonly in whites, and the incidence in
males is twice that of females.[2] Epithelial tumors most commonly present in the fifth and sixth
decades of age.
Although tumors of the nasal cavities are equally divided between benign and malignant types,
most tumors of the paranasal sinuses are malignant. Approximately 55% of sinonasal tumors
originate from the maxillary sinuses, 35% from the nasal cavities, 9% from the ethmoid sinuses,
and the remainder from the frontal and sphenoid sinuses. Squamous cell carcinoma is the most
common malignant histologic type (approximately 70-80%) followed by adenoid cystic
carcinoma and adenocarcinoma (approximately 10% each).[3]
Exposurestoindustrialfumes,wooddust,nickelrefining,andleathertanninghaveallbeenimplicatedin
thecarcinogenesisofvarioustypesofsinonasalmalignanttumors.Inparticular,wooddustandleather
tanningexposuresarewellassociatedwithincreasedriskforadenocarcinoma.[4]Otheretiologicagents
havebeenreportedincludingmineraloils,chromiumandchromiumcompounds,isopropyloils,lacquer
paint,solderingandwelding,andradiumdialpainting.Tobaccosmokingisnotconsideredtobea
significantetiologicfactor;however,recentstudiesdemonstratedahigherincidenceofnasalcancersin
cigarettesmokers

11. Discuss the surgical management of inverted papillomaendoscopic vs. open approaches.
Laryngoscope 2001;111:1395-1400.