Clinical Case CC01

Friday, November 14th, 2025 11:45 – 12:00
Speaker Laura Giles

Case report: Palliative approach to a primary squamous cell maxillary sinus carcinoma with orbital involvement

Due to the vast diversification of tissues located within the head and neck, we can subdivide sinonasal malignancies further based on their histological components. Overall, squamous cell carcinomas account for around 50-75% of this type of malignancy [1]. This case report details the history of a 69 year old gentleman with palliative T4a N0 M0 squamous cell sinonasal carcinoma and will explore the rationale regarding this patient’s management, focusing on a multimodality approach given the complexity of the anatomy and infiltration of the tumour.

This patient presented with visual disturbance, left sided facial swelling and paraesthesia. He had significant lateral displacement and proptosis of the left eye, with absolute vision loss and restricted eye movements. CT imaging showed evidence of a large maxillary lesion destructing through the uncinate process into the left nasal cavity and ethmoid sinus. Superiorly, there was evidence of destruction into the orbital floor, invading into the inferior and medial rectus muscles. It also showed significant compression to the orbit. Anteriorly, the lesion eroded into the subcutaneous tissue and skin. Posteriorly, the lesion abutted the base of skull and evidence of asymmetry between the foramen rotundum concluded that there was likely perineural involvement. Histology from endoscopic biopsy demonstrated a poorly differentiated keratinising squamous cell carcinoma originating from the left maxillary sinus.

Given the extent of the tumour infiltration, it was not feasible to resect the tumour with enough margin, particularly close to the base of the skull. The curative options were limited, and a conclusive decision was made to focus on palliative care. He subsequently began palliative radiotherapy, receiving 5 fractions of 25Gys to the orbit, maxilla and soft palate. Alongside this, the focus shifted towards symptomatic management such as optimal pain control and good eye care, which ultimately aligned with the patient’s wishes.

[1] Resteghini, C. et al, (2025) ‘Sinonasal malignancy: ESMO–EURACAN clinical practice guideline for diagnosis, treatment and follow-up’, ESMO Open, 10(2), p. 104121. doi:10.1016/j.esmoop.2024.104121.