Epidemiological Survey of Sinonasal Malignancy in North-East Iran

Document Type: Original


1 Department of Otorhinolaryngology- Head & Neck Surgery, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Student of Medical Sciences, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Sinonasal malignancies are uncommon neoplasms with several histological subtypes. These malignancies have a poor prognosis and, because of the nonspecific nature of the symptoms, most patients are diagnosed late when the disease is already at an advanced stage. Therefore, most sinonasal malignancies tend to be treated with surgery and postoperative radiotherapy. Understanding the incidence and prevalence of clinical symptoms, pathology, diagnosis, and subsequent prognosis of the disease is important for early diagnosis.
Materials and Methods:
Medical records of patients with a confirmed diagnosis of sinonasal malignancy in a tertiary referral center from 1998 to 2009 were retrospectively investigated by chronological examination. Information relating to symptoms, pathology, and treatment of patients were collected from the checklists and used to generate tables and graphs, while descriptive statistical tests were used to compare data.
The records of 69 patients were examined, including 45 (65.2%) male and 24 (34.8%) female patients with a combined mean age of 54.07±16.04 years. Twenty-one patients (30.4%) were aged less than 45 years and 48 (69.6%) were more than 45 years of age. The most common symptom was facial swelling in 46 (66.6%) patients and the most common kind of tumor was squamous cell carcinoma in 28 (40.6%) patients. The primary location of the tumor in most patients was the maxillary sinus (54 patients; 78.3%). A majority of patients present in advanced stage (stage III or more) with intraorbital (39.1%) or intracranial (4.3%) involvement, or regional lymphatic (28.99%) or distance metastasis (7.2%). The most common treatment was surgery (17 patients; 24.6%).
Due to their nonspecific symptoms, most sinonasal malignancies are diagnosed at an advanced stage of the disease. Therefore, all patients with nonspecific symptoms, especially older males, should be evaluated for sinonasal malignancies in order to eliminate this diagnosis.


Main Subjects

1. Schröck A, Göke F, Van Bremen T, Kirsten R, Jakob M, Ehrenberg T, et al. Sinonasal tract malignancies: a 14-year single institution experience HNO 2012; 60(12):1041–46.

2. Muir CS, and Nectoux J. Descriptive epidemiology of malignant neoplasms of nose, nasal cavities, middle ear and accessory sinuses. Clinical Otolaryngology & Allied Sciences 1980; 5(3):        195-211.

3. Schwaab G, Julieron M, Janot F. Epidemiology of cancers of the nasal cavities and paranasal sinuses. Neurochirurgie 1997;43(2):61–3.

4. Comba P, Belli S. Etiological epidemiology of tumors of the nasal cavities and the paranasal sinuses. Ann Ist Super Sanita 1992; 28(1):121–32.

5. Harvey RJ1, Dalgorf DM. Chapter 10: Sinonasal malignancies. Am J Rhinol Allergy 2013; 27 Suppl 1:S35–8.

6. Kim CH, Song KS, Kim KS, Kim JY, Lee BJ, Lee JG, et al. Sulindac sulfide-induced apoptosis in sinonasal cancer cells. Acta Otolaryngologica 2005; 125(2): 201–6.

7. Zyłka S, Bień S, Kamiński B, Postuła S, Ziołkowska M. Epidemiology and clinical characteristics of the sinonasal malignancies. Otolaryngol Pol 2008; 62(4):436–41.

8. Betlejewski S, Bilewicz R, Stankiewicz C, Skorek AGierek TWardas P, et al. Malignant tumors of the nose and paranasal sinuses in the years 1992–2001. Otolaryngol Pol 2006; 60(5): 729–36.

9. Wang X, Shi G, Liu Y, Ji H, He M, Li J, et al. Analysis of the clinical and pathological characteristics of sinonasal neoplasms. Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery 2011; 25(23):1071–5.

10. Jurkiewicz D, Wojdas A, Hermanowski M. Malignant tumors of the nose and paranasal sinuses in the years 1971–2005 in the material of the Otolaryngology Clinic WIM. Otolaryngol Pol 2007; 61(4):572–5.

11. Khandesi B, Moradi A, Hoseini S, Mohammadian panah M. Malignant neoplasms of  the sinonasal tract: Report of 71 patients and literature review and analysis. Oral Maxillofac Surg 2009; 13:191–99.                                                                        

12. Poetker DM, Toohil RJ, Loehrl TA, Smith TL.   
Endoscopic management of sinonasal tumors: a preliminary report. Am J Rhinol. 2005; 19(3):307–15.

13. Motamed O. Evaluation the frequency and clinical symptoms and surgeries of malignant paranasal tumors in hospitalized patients related to Tehran University of Medical Sciences between 2000 to 2009. Thesis related to Tehran University of Medial Sciences, Tehran, Iran, 2009.                

14. Fasunla AJ, Lasisi AO. Sinonasal malignancies: a 10-year review in a tertiary health institution. J Natl Med Assoc 2007; 99(12):1407–10.

15.  Ernest A, Weymuller JR, Greg ED. Malignancies of the paranasal sinuses. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, et al, editors. Cummings Otolaryngology Head and Neck surgery. 5th ed. Philadelphia: Mosby Elsevier; 2010. 2. 1121–33.

16. Hwang PH, Abdolkhani A. Embryology, anatomy and physiology of the nose and paranasal sinuses. In: Snow JB, Wackym PA, editors. Ballenger’s Otorhinolaryngology Head and Neck Surgery. 17th ed. Shelton: BC Decker 2009.455–63.                                                                                                                   

17. Gerhard G. Anatomy, physiology, and immunology of the nose, paranasal sinuses and face. In: Rudolf P, Gerhard G, Heinrich I, editors. Basic otorhinolaryngology a step by step learning guide. 2nd ed. Stuttgart: Georg Thiem Verlag 2008:1–25.                                                                                               

18. Junqueira LC, Carneiro J. The respiratory system. In: Junqueira LC, Carneiro J. Basic histology.10th ed. New York: McGraw Hill 2010: 349–5.                                  

19. Mandpe HA, Paranasal sinus neoplasms. In: Lalwani KA, Otolaryngology Head and Neck Surgery Current Diagnosis and Treatment. 2nd ed. New York: McGraw Hill 2008: 287–94.                                                                                                                               

20. Chalastras T, Elefteriadou A, Giotakis J, Soulandikas K, Korres S, Ferekidis E, et al. Non-Hodgkin’s lymphoma of nasal cavity and paranasal sinuses. A clinicopathological and immuno- histochemical study. Acta Otorhinolarhingol Ital 2007; 27(1):6–9.                                                                                                                                                                            

21. Zylka S, Bein S, Kaminski B, Postula S, Ziolkowska M. Epidemiology and clinical characteristics of the Sinonasal malignancies. Otolaryngol Pol 2008; 62(4):436–41.