Oral & Maxillofacial Pathology

1. Carcinoma of maxillary
sinus, nasopharngeal
carcinoma
Dr. Asifa Iqbal
BDS MPhil (Oral Pathology & Microbiology)
FCPS OMFS(II)
KING EDWARD MEDICAL UNIVERSITY ,LAHORE.

2. Carcinoma of maxillary sinus
 Anatomy of sinus
 Carcinoma
 Clinical features
 Leads to tratment planning

3. Anatomy of maxillary sinus

5. Pathogenesis
 Normal  Hyperplasia  Metaplasia (DNA damage) 
Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA
damage) Infiltration  (DNA damage)  Metastasis….
 Progressive DNA Damage – features of neoplasia.

6. Clinical features
 Uncommon
 Dangerous
 Incidence less than other intra oral sites
 642 cases in 10 yr literature survey
 Age elderly
 Sex male more
 Etiology not definite
 No predisposing factors like ch.sinusitis polyp

7. Clinical features
 Presents usually as
 nasal stuffiness ,
 ulcer ,
 mass
 nerve involvement tooth ach
 loosening of denture

8. With spread
 Lateral wall ---facial asymmetry
 Medial wall --- nasal stuffiness
 Superior ----protrusion of eyeball
 After lymph node metastasis
 submandibular or cervical
 Distant metastasis uncommon

10. staging
 0 inner lining
 1 mucous mem
 2 bone
 3 bone at back of sinus ,underlying tissue
under the skin,eye ball or lymph nodes less
than 3 cm
 4 A,B,C.


11. radio graphically

12. histopathology

13. Sinonasal undifferentiated
tumour
 Trabaculea and nest of polygonal cells with
minimal cytoplasm pleomorphism
hyperchromatism .
 Immunhistostaining positive cytokeratin

14. treatment
 Surgical Hemimaxilectomy
 Radiotherpy
 Prognosis poor 10 -30% 5 yr survival
 Poor prognostic indicators
 lymph nodes
 anatomical difficulty pteygopalatine
fossa

15. Nasopharyngeal carcinoma
 Group of malignancies arising from
epith.lining of lymphoid rich nasopharynx
 Similar tumour found in palatine tonsils and
base of tongue

18. Clinical features
 Tumour of Cantonese (south china)
 Second most frequent tumour in female
 age
 Etiology
 racial
 EBV Association EBNA-1
 Linked with diffrentiation
 undifferentiated always positive for EB-
viral antigen
 HLA Typing
 Contributing factors Salt fish ,nitrosamine

19. Clinical features
Site of primary lesion Post. or lat.wall.
Difficult to assess
Enlarged lymph node50-60% presentation
 Symptoms of primary invasion
 Epistaxis ,nasal obstruction,partial deafness
 Cranial nerves palsies.
 Rapidly fatal laryngeal ,pharyngeal
obstrution.

20. histopathology
 SCC keratinizing
 Diff.non-keratinizing
 Undiffer.nonkeratinizing
 Anaplastic lymphowpith.
 Sinonasal undifferentiated

22. diagnosis
 Lateral view
 CT scan
 MRI

23. treatment
 Surgical difficult
 Radiotherapy
 Chemotherapy!
 Survival rate in US
 Stage1 100%
 stage 2 67%
 stage3 44%
 stage4 34%