Introduction: Reconstruction of the nose and cheek after oncologic resections or severe infections resulting in facial necrosis is challenging.Sometimes different facial regions must be repaired, and different flaps must be used to achieve a good functional and aesthetic result.Local flaps and in cases of extensive defects, regional flaps are an excellent option for the reconstruction.

Background: In this study, we describe our experience in the treatment of malignant rhinosinusal tumors and establish factors related to their prognosis.Objectives: To determine the local control and the survival rates in patients with malignant tumors of the paranasal sinuses and nasal cavity treated by endonasal endoscopic surgery. Design: Descriptive and prospective.Methods: All patients who had malignant tumors of the nasal cavity and paranasal sinuses who were treated by an endonasal, cranionasal or combined endonasal an external approach in the ENT Department of the Italian Hospital of Buenos Aires from March 2003 to August 2019 were selected. Patient data were collected prospectively and updated by reviewing electronic medical records.Results: Thirty patients were treated, 10 had tumors located in the nasal cavity. No patient had local recurrence.Twenty had malignant tumors originated in the paranasal sinuses. Twelve endonasal approaches were performed with endoscopes only, 9 had adjuvant treatment with radiotherapy and chemoradiotherapy. The local control rate was 50% (6/12). Six cranionasal approaches were made: All had adjuvant treatment with radiotherapy or chemoradiotherapy and two others were treated by an endonasal and external approach, and postoperative radiation therapy.The local control rate in patients treated with cranionasal and combined approaches was 75%. Conclusions:The rate of local control and survival that we obtained in patients treated for rhinosinusal malignant tumors by endonasal endoscopic surgery was 73.33%.Tumors with greater extension and infiltration, with higher T staging, localization in the paranasal sinuses and unfavorable histologies such as undifferentiated carcinoma, had a greater need for neoadjuvant or adjuvant treatment and worse prognosis than those small, T1-2, and localized neoplasms in the nasal cavity.

Introduction: Malignant neural sheath tumors located in the head and neck region are very rare. Surgical treatment if possible is the best option, trying to obtain wide resection margins free of tumor. Objects:To determine the incidence of malignant tumors of neural histology, in relation to nerve tumors originating in the head and neck and description of two clinical cases. Methods:A retrospective and descriptive study was carried out by reviewing the electronic medical records of all patients who were diagnosed and treated for neural histology tumors originating in the head and neck, between March 1998 and December 2021.Results: Eighteen patients were treated for nerve tumors originating in the head and neck. The benign tumors of neural origin were located in the nasal cavity and paranasal sinuses (6/18) and in the neck (10/18). Four originated from the facial nerve in the parotid, three from the cervical sympathetic nerve in the retro styloid carotid space, one in the submaxillary region, and two in the supraclavicular fossa.The incidence of malignant nerve tumors was 11.11% (2/18). Conclusions:The incidence of malignant neural sheath tumors in our study was 11.11%. Most neural sheath tumors are benign and can cause functional alterations due to compression of the nerve of origin or adjacent structures, but when the neoplasm grows rapidly malignancy should be suspected. The main treatment is surgery trying to obtain wide tumor-free margins.

Objectives: Schwannomas of the nasal cavity and paranasal sinuses are uncommon. Treatment is surgical and endoscopic excision is a main indication. Our aim was to determine the incidence of rhinosinusal Schwannomas and the effectiveness of endonasal surgery with endoscopes to treat these tumors. Methods:The electronic medical records of all patients diagnosed with head and neck schwannomas were reviewed, excluding acoustic nerve neurilemomas and neurofibromas. Those who presented tumors located in the nose or paranasal sinuses were selected. They were treated with surgery in the Rhinosinusology section of ENT Department of the Hospital Italiano de Buenos Aires between March 1998 and December 2019.Results: Eighteen patients were selected who had histological (15/18) and clinical and imaging (3/18) diagnoses of neural type neoplasia, located in the head and neck.Two neck neurofibromas were excluded.Five patients with schwannomas located in the nasal cavity and paranasal sinuses were treated with surgery and had histopathological confirmation.The surgical technique varied according to the time of its indication.In four patients, an endonasal approach with endoscopes alone or combined with a frontal craniotomy was performed and in another a sublabial approach was made.The resection was complete in 4 patients and subtotal in another (intracranial extension with bilateral compromise of visual acuity). Conclusions:The incidence of sinonasal schwannomas within the nerve tumors diagnosed in the head and neck was 31.25% (5/16).Endoscopic excision was very safe and effective to treat the patients with sinonasal schwannomas.

Two patients who had squamous cell carcinomas of the nasal cavity with extension to the nasal septum and previous treatments with surgery and in another with surgery and radiotherapy were treated by rhinectomy.The reconstruction of the internal mucosal lining was done with mucoperiosteal flaps from the lateral nasal wall with anterior pedicle with the assistance of endoscopes.There are few descriptions in the literature of the use of this flap to reconstruct the inner lining after rhinectomy.