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\begin{document}

\title{Total rhinectomy and prosthesis for nasal carcinoma}



\author[1]{Cesar Gamaliel Rivera Martinez.}%
\author[1]{Edgar Hernandez Abarca}%
\author[1]{José Busto Ruano}%
\author[2]{Mayrelle Martinez Quincosa}%
\author[3]{Raymundo Benjamín Priego Blancas}%
\affil[1]{Hospital Central Militar}%
\affil[2]{Instituto Tecnológico y de Estudios Superiores de Monterrey Escuela de Gobierno y Transformación Pública}%
\affil[3]{Hospital General Dr Manuel Gea Gonzalez}%


\vspace{-1em}



  
  \date{June 17, 2024}


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\selectlanguage{english}
\begin{abstract}
Squamous cell carcinoma is one of the most common head and neck types of
skin cancer. This main objective of this paper is to present a case of a
patient who had a moderately differentiated squamous cell carcinoma of
the nose and whose tumor had an aggressive growth.%
\end{abstract}%



\sloppy


\textbf{Case report:}

\textbf{Total rhinectomy with prosthesis placement as a treatment for
moderately differentiated squamous cell carcinoma of the nose}

\textbf{Total rhinectomy and prosthesis for nasal carcinoma}

\textbf{Case report:}

\textbf{Total rhinectomy and prosthesis for nasal carcinoma}

Dr. C\selectlanguage{ngerman}ésar Gamaliel Rivera Martínez\textsuperscript{1}, Dr. Edgar
Hernández Abarca\textsuperscript{2,} , Dr. José Pablo Busto
Ruano\textsuperscript{3}, Mayrelle Martínez Quincosa\textsuperscript{4},
Raymundo Benjamín Priego Blancas\textsuperscript{5}

\begin{enumerate}
\tightlist
\item
  MD otorhinolaryngology head and neck surgeon, staff physician at the
  department of otorhinolaryngology at the Central Military Hospital,
  Mexico City.
\item
  MD otorhinolaryngology head and neck surgeon, at the Central Military
  Hospital, Mexico City
\item
  MD otorhinolaryngology head and neck surgeon, staff physician at the
  department of otorhinolaryngology at the Central Military Hospital,
  Mexico City.
\item
  MD Internship at Instituto Tecnológico de Estudios Superiores de
  Monterrey, Mexico City.
\item
  MD plastic and reconstructive surgeon, staff physician at Centro
  Médico ABC, Mexico City
\end{enumerate}

\emph{Conflict of interests}

The authors of this manuscript certify that they have NO affiliations
with or involvement in any organization or entity with any financial
interest or non-financial interest in the subject matter or materials
discussed in this manuscript.

Corresponding Author:

Name: José Pablo Busto Ruano

Affiliation: Central Military Hospital in Mexico.

Address: Av Irrigación 108, int. 1. Col. Irrigación, Miguel Hidalgo. CP
11500, Mexico City

Tel: +52 55 22 99 32 34

E-mail: josepablobusto@gmail.com

\textbf{Acknowledgments}

None

\textbf{Introduction}

The nose is a typical subsite of head and neck skin cancers, being the
squamous cell carcinoma one of the most common histological
subtypes\textsuperscript{1,2,3} .This type of tumor shows a locally
aggressive growth and tends to invade cartilage and deeper structures
requiring a subtotal or total rhinectomy when they are larger than 1
cm\textsuperscript{1,2}. Compared to primary radiation approaches and to
subtotal rhinectomy with skin flap reconstruction, which can lead to a
malignant lesion recurrence after 3 years post intervention, total
rhinectomy with prosthesis placement has shown excellent outcomes and
better tumor growth control rates, as well as a decrease in mortality
rates \textsuperscript{1,2.3}.

Although total rhinectomy leads to excellent tumor control, it alters
the patient's appearance and disturbs facial harmony. On one hand most
of these patients require radiotherapy which can affect the quality of
the bone and tissue. In these cases it is difficult to reconstruct the
nose aesthetically and functionally with skin flaps \textsuperscript{1}.
For this reason, an excellent alternative is a nasal prosthesis which is
safe and implies better oncological control and limits tumor
recurrences. This device also mimics the original appearance and
function of the nose prior to surgery, thereby improving the patient's
quality of life \textsuperscript{2}.

The main objective of this manuscript is to present a case of a patient
with moderately differentiated squamous cell carcinoma of the nose, who
underwent total rhinectomy and posterior reconstruction with nasal self-
retained prosthesis.

\textbf{Case Report}

An 88-year-old patient with a history of epidermoid carcinoma on the
left cheek skin resected 12 years ago. He had a lesion in the right
nasal wing with full-thickness perforation and the presence of an
obstructing tumor in the entire right nostril, invading the septum for
the last 2 years. (Fig. 1, Fig. 2.)

The CT reported tumor invasion of the nasal wing, septum, right nasal
dorsum, right inferior turbinate in its frontal area; it did not involve
nasal floor, maxilla or paranasal sinuses. It was staged as T3N0M0
according to AJCC eighth edition of primary cutaneous carcinoma. A
biopsy was taken with histopathological results of moderately
differentiated squamous cell carcinoma.

Total rhinectomy was scheduled, which was performed without
complications, obtaining a pathology result that confirmed moderately
differentiated, invasive and ulcerated squamous cell carcinoma of 3.3 x
2.3 cm deep that invaded the nasal mucosa up to the elastic cartilage of
the nasal septum and negative skin edges for neoplasia (T3N0M0). (Fig.
3). The patient received adjuvant radiotherapy (45 Gy in 15 sessions)
with no complications nor recurrence due to clinical manifestations or
PET-CT during 1 year follow-up.

4.5 months after the rhinectomy, the patient showed healing of the skin
and mucosa of the nasal defect. Therefore the reconstructive surgery
department evaluated a nasal prosthesis placement. Maxillofacial
department was in charge of the prosthesis impression. The implant-
retained prosthesis was made out of silicone, mimicked the natural skin
of the patient and was chemically attached. (Fig.4)

\textbf{Discussion}

In this case, the patient underwent a total rhinectomy which was
preferred based on the histological type and the rapid growth, which led
to better tumor control. No immediate adverse effects were present
during the rhinectomy procedure nor the prosthesis placement.
Nevertheless a long term tumor recurrency should be followed.

Although rhinectomy promises a lower risk of recurrence and good tumor
control, it is important to mention the adverse effects, which can be
either local symptoms such as numbness, swelling and tightness of the
face as well as generalized symptoms such as headache, lightheaded and
burning sensation, which did not occur in this
patient.\textsuperscript{2,4}

Tissue invasion by this tumor required surgery which causes severe
facial deformity and decreased nasal function. Unlike nasal
reconstructions with autologous flaps, the type of prosthesis used does
not require subsequent surgical approaches and is not affected by bone
and tissue damage after adjuvant radiotherapy. \textsuperscript{4}

In addition, it improves the quality of life as it gives a good
functional and aesthetic result. By having a self- retained prosthesis
with similarity to the natural nose prior to surgery, it increases the
patient's self-esteem and social activity. It is important for the
patient to go to therapy or get used to the prosthesis because
functionality might get altered. Although it is recovered, it can cause
difficulty in communication, breathing, swallowing, eating and
drinking.\textsuperscript{2}

\textbf{Conclusion}

Squamous cell carcinoma is one of the most frequent histological
subtypes of tumors of the head and neck. The patient presented a
moderately differentiated squamous cell carcinoma of the nose which
invaded the nasal wing, septum, right nasal dorsum and right inferior
turbinate in its frontal area. Therefore requiring a total rhinectomy
and adjuvant radiotherapy as treatment, no complications were reported.

Total rhinectomy not only involves facial deformity, functional and
psychological impairment are also seen. Adjuvant radiotherapy causes
bone and tissue damage, which is why chemically self-retained nasal
prosthesis is the treatment of choice, as it decreases tumor recurrence,
does not require subsequent surgical approaches and improves both nasal
function and facial aesthetics by matching the shape and nasal skin of
the patient prior to the condition.

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Javanmard A, Mohammadi F, Mojtahedi H. Reconstruction of a total
  rhinectomy defect by implant-retained nasal prosthesis: A clinical
  report. \emph{Oral Maxillofac Surg Cases}. 2020;6(1):100141.
  doi:10.1016/j.omsc.2020.100141
\item
  D'heygere V, Mattheis S, Stähr K et al. Epithetic nasal reconstruction
  after total rhinectomy: Oncologic outcomes, immediate and long-term
  adverse effects, and quality of life. \emph{Journal of Plastic,
  Reconstructive \&amp; Aesthetic Surgery}. 2021;74(3):625-631.
  doi:10.1016/j.bjps.2020.10.013
\item
  Girardi F, Hauth L, Abentroth A. Total rhinectomy for nasal
  carcinomas. \emph{Braz J Otorhinolaryngol}. 2020;86(6):763-766.
  doi:10.1016/j.bjorl.2019.06.002
\item
  Ethunandan, M., Downie, I. and Flood, T., 2010. Implant-retained nasal
  prosthesis for reconstruction of large rhinectomy defects: the
  Salisbury experience. \emph{International Journal of Oral and
  Maxillofacial Surgery}, 39(4), pp.343-349.
\end{enumerate}

\textbf{Figures:}

Fig. 1. Patient with nasal tumor.

Fig.2. Patient with nasal tumor.

Fig.3. Patient with nasal defect after total rhinectomy.

Fig. 4. Patient with the nasal prosthesis insertion.\selectlanguage{english}
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