The "silent" progression of a secondary paranasal malignancy in a laryngectomized patient

We discuss a 56-year-old white male patient who presented, 36 months after total laryngectomy for a primary vallecular carcinoma, with frontal headaches and left-sided nasal discharge since 5 months. Initially he was treated with antibiotics for a presumed sinusitis. In due course, bilateral paranasal swelling, left-sided eye pain and diplopia occurred. By then, physical examination and MRI imaging showed an irresectable left-sided paranasal tumour. He was then treated with palliative chemotherapy. Considerable diagnostic delay occurred in this metachronous second primary carcinoma, by the lack of nose breathing after total laryngectomy, thus not noticing nasal obstruction as a first sign. The rare occurrence of second primary tumour of the nose and paranasal sinuses in patients who underwent a laryngectomy obliges us to investigate vague nasal complaints by rhinoscopy and imaging.