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Patients with persistent or recurrent ITP after LS should undergo radionuclide imaging to identify any residual accessory splenic tissue. 58 for anatomy) 10 regional metastatic potential; 60 5-year survival; worse prognosis for larger tumors, extension outside the nasal cavity, bony involvement, and regional metastasis Anterior Cranial Fossa: bordered posteriorly by the lesser wing of the sphenoid and optic chiasm and extends to the frontal bone; the floor contains the orbital plates of the frontal bone, fovea ethmoidalis, and cribriform plate Pterygopalatine Fossa: pyramidal-shaped space below the apex of the orbit and between the posterior wall of the maxillary sinus and the pterygoid plates; contains the foramen rotundum (CN V2), vidian nerve, sphenopalatine nerve, lesser and greater palatine nerves, sphenopalatine ganglion, and internal maxillary artery; invasion of this space carries a poor prognosis Infratemporal Fossa: bounded anteriorly by the maxilla, posteriorly by the glenoid fossa and mandible, and medially by the lateral pterygoid plates; roof contains the foramen ovale (CN V3) and spinosum (middle meningeal artery and vein), also contains the pterygoid muscles Orbital Cavity: invasion into bony orbit or orbital apex requires orbit exenteration Pathology Epithelial Malignancy Squamous Cell Carcinoma: most common malignancy in sinonasal tissue, nasosinusoidal lesions are more aggressive and have a higher rate of metastasis, majority are moderately differentiated keratinizing type Adenocarcinoma: increased instances with wood and leather workers, presents more commonly in the ethmoid sinuses Adenocystic Carcinoma: salivary gland tumor (more common in the minor salivary glands), insidious growth (distant metastasis may present years later), perineural extension may present with pain Mucoepidermoid Carcinoma: rare, salivary gland tumor Melanoma: usually metastatic, more common in nasal cavity (anterior nasal septum), high risk of local recurrence generate large temporal stimuli.
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