Minor Salivary Gland Carcinoma Extending to Intracranial, Retroorbital and Sinonasal Cavity: Case Report

We report a case of huge minor salivary gland carcinoma extending to intracranial, retroorbital and sinonasal cavities. The patient was a 51-year-old man who had progressive nasal obstruction, decreased visual acuity and headache. Brain computed tomography and magnetic resonance image revealed a huge heterogeneous enhancing mass with extensive bony destruction originating from right maxillary sinus and both nasal cavities to the frontal base structures. The tumor mass was approached by a craniofacial route and subtotal removal was done because of its marked invasion of cavernous sinus, parasellar structures and hypothalamus. The histological diagnosis was minor salivary gland adenocarcinoma.

Anterior Approaches to Midline Skull Base Tumors

Among various approaches to midline skull base tumors, anterior approaches can provide excellent visualization of the lesion. Since June 1989, 12 anterior procedures have been carried out on 9 consecutive patients presenting with midline skull base tumors(four transsphenodal approches, three Le Fort I osteotomies. Two lateral rhinotomies, two facial translocation approaches, and one craniofacial approach). These anterior procedures allowed good access to the lesions. Wound healing was rapid, with little discomfort to the patients. Cosmetic results were also excellent, and there were no significant problems related to malocclusion in the cases of Le Fort I osteotomy. Patients who underwent facial translocation approach developed nasolacrimal duct obstruction and small area hypesthesia on the cheek. Postoperatively, two patients died from tumor progression and meningitis secondary to CSF leakage, respectively. Although the number of cases and follow-up period are limited in our series, we think that anterior approaches may be useful in the surgical treatment to midline skull base tumors.