Adenoid Cystic Carcinoma of the Anterior Skull Base

Introduction: Head and neck adenoid cystic carcinoma (ACC) is an uncommon salivary gland malignancy with a variable growth pattern and is generally advanced when diagnosed.

Case Report: We present a 47-year-old man with a huge protruding frontonasal mass causing widening of the area. It was associated with intermittent blood-stained nasal discharge. There was no headache, diplopia, proptosis, and loosening of teeth. Clinical examination showed protruding mass measuring 8 × 8 cm over the frontonasal region, causing telecanthus. Nasal endoscopy showed a lobulated fleshy mass arising from the roof of both nasal cavities, and nasal biopsy revealed ACC. Computed tomography of paranasal sinuses revealed an extensive tumor with destruction of frontal bone, nasal bone, medial wall of orbit and ethmoids, and intracranial extradural extension.

Result: He underwent craniofacial resection of the tumor via a bicoronal approach with bifrontal craniotomy and an open sky incision over the nasal bridge. Postoperative recovery was uneventful and he underwent adjuvant radiotherapy.

Conclusion: Adenoid cystic carcinoma involving the skull base presents a major challenge to the head and neck surgeon because of the proximity of the tumor to important neural and vascular structures.