tumors of nose and paranasal sinus dr.sithanandhakumar -13.06.16

TUMORS OF NOSE AND PARANASAL SINUS

CLASSIFICATION

INVERTED PAPILLOMABenign neoplasm

Schneiderian membrane-neuro-ectodermal origin

Conrad Victor Schneider

Accounts for 5% of all benign tumors

Schneiderian papilloma

Ringertz tumor

Transitional cell papilloma

Inverted papillomamicroscopically the neoplastic epithelium is seen

to grow towards underlying stroma.

HPV 6,11

b/w 40-70 yrs

Male preponderance

Lateral nasal wall-mc site of origin

Always unilateral

Inverted papillomaGreyish white /pale pink fleshy firm to rubbery

multiple polypoidal mass arising from lateral nasal wall.

Tendency to recur after sx removal

Associated with squamous cell carcinoma in 10-15% cases

CLINICAL FEATURESU/L NASAL OBSTRUCTION

BLEEDING FROM THE NOSE

U/L NASAL MASS RESEMBLING A POLYP

KROUSE STAGING

CT SCANBone erosion, thinning,

remodelling, sclerosis.

hyperdense areas with linear calcification

TREATMENTMEDIAL MAXILLECTOMY- Endoscopic/External

Lateral Rhinotomy by MOURE’S incision

Hemangioma Capillary haemangioma

Bleeding polypus of the septum

soft, dark red , pedunculated or sessile mass arising from anterior aspect of septum.

Epistaxis

Excision

Cavernous hemangioma-tubinates/lat nasal wall

osteoma Fibrous dysplasiaMc in frontal sinus

Usually assymptomatic

Can obstruct ostium of frontal sinus and cause mucocele

If symptomatic -excision

Bone replaced by fibrous tissue

Maxillary sinus –MC site

Proptosis,nasal obstrn,facial disfigurement

Surgical excision

Malignant tumors

EPIDEMIOLOGYIncidence - 0.5–1 / 1,00,000 / yr

< 1 % of all carcinomas.

Male : female = 2: 1

Whites > blacks

Mean age – 55 yrs ( 5th -6th decade )

Most common – maxillary sinus (55 % )

Malignancy of PNSMaxillary sinus most commonly involved

Followed by ethmoid and frontal sinus

Squamous cell carcinoma –most common histological type

Adenocarcinoma –common in wood workers

Risk factorsInhalation of carcinogens – 40%

Hardwood dust (adenocarcinoma) – 70 times riskSoftwood dust (squamous carcinoma)

Nickel refining (250 times); chromium workers

Boot , shoe & textile workers

Isopropyl oil, volatile hydrocarbons & mustard gas

Thorotrast dye injection

Snuff

Routes of spread

Clinical featuresOral symptoms

Nasal symptoms

Orbital symptoms

Facial symptoms

CNS symtoms

ORAL SYMTOMSDue to inferior spread to alveolus and palate

Seen in 25-40% patients

Dental pulp type pain-ant sup aleolar nerve

Dental extraction-non healing socket

Loosening teeth

Dental malocclusion

Trismus

Palatal bulge/ulcerated growth

Nasal symptomsDue to medial spread

Seen 45-75% patients

u/l nasal obstruction

u/l nasal discharge-blood stained

Orbital symptomsDue to superior spread

Seen 25% of patients

Lid swelling,epiphora

Diplopia , proptosis, impaired vision

Facial symptomsSeen in 40-70% patients

Due to extension through anterior wall

Numbness/paraesthesia of face-infra orbital nerve

Blunting of nasomaxillary fold

Widening of dorsum of nose

Ulcerative growth/fixity to skin

Neurological Spread of disease through

cribriform plate….ant cranial fossa(head ache,anosmia,csf leak)

Posterior wall …pterygopalatine fossa(deep facial pain,trismus)

Orbital apex-----middle cranial fossa-EOM palsy(direct/cavernous sinus)

INVESTIGATIONSDNE AND BIOPSY

CECT SCAN

Ohngren’s line

Lederman staging

Treatment Surgery-total maxillectomy

Surgery+radiotherapy

Sandwich therapy

Radiotherapy …..Surgery…..Radiotherapy

Weber Ferguson incision

Thank you