Rhinectomy for malignant disease. A 20-year experience.

In a 20-year experience with total rhinectomy for malignant disease, 27 of 51 patients had prior irradiation. In five patients, the tumor masqueraded as a dermatosis. Basal or squamous cell carcinomas were the usual histologic types (86%). There had been previous unsuccessful surgical therapy in 31 patients and radiation therapy in 17 patients. Twenty-two tumors recurred at a mean of 9.4 months after rhinectomy; 50% of these patients died. Despite rhinectomy, almost 25% (and 40% of patients with squamous cell carcinoma) died, usually of uncontrolled local disease. Results of surgical reconstruction after total rhinectomy were not satisfactory. In eight of 12 cases, attempts failed primarily or recurrent disease developed. Reconstruction should not be attempted before one year after rhinectomy, and use of a nasal prosthesis is the cornerstone of rehabilitation. Total rhinectomy is an oncologically sound operation for extensive nasal carcinoma.