A Case of Carcinoma of the Frontal Sinus

MALIGNANT disease of the nose and paranasal sinuses is thought to account for 2_ger_cent of all cases of cancer occurring in the Body (Ewing, 1940). According to New and Erich (1945) 6c>65j>er cent of the malignant tumours involving the nose and paranasal sinuses are squamous cell epitheliomas. Eggston and Wolff (1947) have reported that 68 per cent of their cases were epithelial tumours. Sarcomas are commoner in the younger age group. The maxillary sinus is the most frequently involved followed by the ethmoid, sphenoid and frontal sinuses. Primary malignant disease of the frontal sinus is rare; so rare that some authors (Capps, 1949) have stated that it is generally accepted that primary malignant disease occurs only in the maxillary and ethmoid sinuses. Brunner (1953) mentions _two factors which help to explain why tumours arising from the mucosa of the frontal sinus are met with less frequently. Firstly he states that in approximately 5-10 per cent of normal adults the frontal sinus does not develop, whereas the ethmoid and maxillary always develop in normals. Secondly he points to the fact that there was a wide jpar ty" wall between the maxillary and ethmoid sinuses on one hand, and the nasal passages on the other hand. This wall is very thin. In contrast there was a small "party" wall between the frontal sinuses and the nasal passages, but this wall, viz. the nasal spine of the frontal bone is very thick. The result is that primary tumours of the frontal sinus have a latent course for a comparatively long time, until they grow into the orbit, the skull, forehead, or into the ethmoids. A review of the literature on primary malignant disease of the frontal sinus shows that in the great majority of cases reported the lesion had involved the_neighbouring sinuses or contiguous structures but in each case the frontal sinus was surmised as the site of origin. The chief reason for this supposition was that the bulk of the tumour lay Jn the frontal sinus, a conclusion which is open to doubt. Primary carcinoma according to Ward and Hendrick (1950) involves the frontal sinuses after the ethmoids in frequency of occurrence. They reported four cases in their series, three of epidermoid carcinoma and one was reported just as carcinoma. Due to the rarity of the disease they admitted that their experience in the treatment of frontal sinus carcinoma was limited but advocated application