A 21-year-old female patient, with no family history of interest, with a history of strabismus intervention 6 years before and after smoking (10 cigarettes/day).
He begins a study in his otorhinolaryngologist (ORL) due to a 2-month history of right nasal respiratory distress with loss of taste, anosmia, epistaxis and occasional right epiphora, associated with severe headache.
The ENT examination revealed a mass occupying the entire right nostril and impeded the passage of the septal deviation to the left nasal fossa, with biopsy suspecting an undifferentiated tumor.
No palpable lymph nodes were detected.
Blood tests and chest X-ray were normal.
A computerized axial tomography (CAT) and a craniofacial magnetic resonance imaging (MRI) were requested, in which a tumor was observed in the right maxillary sinus, displacing the septum and affecting ethm cells.
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The patient underwent surgery with ethmoid craniofacial resection and medial facial translocation, which allowed us to see that the tumor occupied the entire right maxillary sinus and posterior maxillary sinus-up compression cells, with which the tumor displaced the medial maxillary wall.
The tumor filled submucosally all the right fossa and part of the sinus was nasal.
Pathological study reports neuroesthesioblastoma, Kádish B stage.
In the immediate postoperative period she suffered a bacterial meningitis with satisfactory evolution.
In postsurgical MRI, only postsurgical changes are observed.
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Following evaluation in a Subcommittee of head and neck tumours, it was decided to perform post-operative radiotherapy, receiving a total dose of 60 Gy tumour bed using a virtual simulation technique and a three-dimensional (3D) 3D plan on a personalised tomography (CT scan 5 Gy personalised radiation therapy versus a personalised radiation dose per patient x 109/ l
A dose homogenization system with tissue compensation wedges was used, as well as facial thermoplastic immobilization with a face mask for adequate sensitivity throughout the treatment.
Tolerance is good, with acute dermal toxicity grade 1 (G1), and grade 2 mucosa (G2).
After 4 weeks, the irradiation was reoperated due to oroantral fistula in the right gingival sulcus at the level of the first molar.
Seven months later, she was reoperated with a craniofacial approach due to foreign body granuloma in the left frontal cavity with no histological data of recurrence.
Currently, 26 months after the first intervention, there is no evidence of local recurrence, with complete remission and active normal life.
