Background. The majority of tumors of the nasal cavity and paranasal sinus are diagnosed at an advanced stage, requiring invasive and mutilating surgery, and therefore, the reconstruction of post-surgical craniofacial bone defects using various implants is necessary.Purpose of the study: to evaluate the effectiveness of the use of the thin-profile implants made of titanium nickelide in the surgical treatment of nasal cavity and paranasal sinus cancers.Material and Methods. From 2002 to 2020, a total of 60 patients with stage Т3–4n0–1M0 nasal cavity and paranasal sinus cancer were treated at the Cancer Research institute (tomsk). All patients received radiation therapy followed by surgery with reconstruction of bone structures of the subcranial region and orbital walls. In the study group (n=30), the orbital walls were restored with individual thin-profile shape memory titanium nickelide implants. In the control group (n=30), typical porous and tissue titanium nickelide implants were used. They required adjustment during surgery and complicated reparative processes in the postoperative period due to their thickness. Tissue implants did not allow accurate restoration of the orbital walls due to their structure.Results. Surgical rehabilitation with orbital wall reconstruction using thin-profile titanium nickelide implants makes it possible to shorten the duration of surgery and improve the precision of surgical repair. Features of the architectonics of implants do not interfere with the growth of tissues of the recipient zone, thus preventing the development of inflammation in the implantation site. The technique allows adequate restoration of the natural position and function of the eye.

The preliminary treatment outcomes for 8 patients with sinonasal carcinoma have been presented. All the patients received a multimodality treatment including thermoradiotherapy followed by the operation and intraoperative radiotherapy. Clinical testing of the method of the combined treatment of sinonasal carcinomas with local hyperthermia has showed that the positive effect was achieved in all patients without causing pronounced complications during the treatment. Further studies with careful quality control are required to solve the existing problems of local hyperthermia in the head and neck region before this method of treatment can be recommended for a wide clinical application.

Obvious advantage of IORT (intraoperative radiotherapy) is that the radiation source is delivered directly to the bed of the tumor during surgery, thus avoiding the negative impact on the skin, subcutaneous tissue and reducing the risk of fibrosis. Sinonasal tumors-a convenient object for intraoperative radiotherapy application (surface location, relatively small size tumors, good operational access). The surface location and comparatively small size of neoplasms, good operational access provide an efficient and accurate transfer of the electron beam to the postoperative cavity to increase the irradiation dose in the areas of the most probable recurrence, which makes the tumors of this localization a convenient object for the use of the intraoperative radiation therapy. The treatment was conducted using a mobile compact betatron (MIB-6E), 10-12 Gy single dose. IORT session extends surgery period by 30 min. There were no pathological clinical and laboratory reactions on IORT in the early postoperative period. Carrying out the procedure is possible in various standard operating rooms. It does not require special security measures for the patients and the staff. IORT with the help of electron beam allows avoiding post-radiation reactions and achieving a 5-year-disease-free survival of 66% of the patients. IORT session is possible through a minimal incision during organ preservation surgeries. Evident economic feasibility provides the prospects of applying IORT in the clinical practice.

Results of the combined modality treatment for patients with cancer of accessory sinuses using the modern surgical technologies based on individual endoprosthesis of postoperative bone defects have been presented. Stimulation of reparative processes in the wound with the use of low intensity laser infra-red radiation and permanent magnetic field was performed in early postoperative period. The application of the above methods allowed the reduction in rehabilitation period, increase in the level of social adaptation of the patients and improvement of cosmetic and functional effects of the treatment.