1. MALIGNANT TUMORS OF NOSE
AND PARANASAL SINUSES
Dhanushree G
6th term
SSIMS Davangere
2. INTRODUCTION
● Both benign and malignant tumors of nasal cavity per se
are uncommon
● Nasal cavity can be invaded by growths from
PNSs,nasopharynx,cranial or buccal cavity
● Malignant tumors : friable, have granular surface,tend to
bleed easily
5. CARCINOMA OF NASAL CAVITY
It may be extension of maxillary or ethmoid carcinoma.
SCC - Arise from vestibule, anterior part of nasal septum or
lateral wall of nasal cavity.
Adenocarcinoma-They arise from the glands of mucous
membranes or minor salivary glands and mostly involve
upper part of lateral wall of nasal cavity.
6.
7. MALIGNANT MELANOMA
● 50 years of age
● Both sexes are equally affected
● Presents as a slaty-grey or bluish black polyploid
mass within the nasal cavity,
● Most frequent site is the anterior part of nasal
septum followed by middle and inferior turbinate
● Tumor spreads by lymphatics and blood stream
● Treatment- Wide surgical excision.
8. OLFACTORY NEUROBLASTOMA
● Also called Esthesioneuroblastoma
● Tumor of olfactory placode
● Either sex at any age group
● Presents as cherry red polyploid mass in the
upper third of the nasal cavity
● TREATMENT - Surgical excision followed by
radiation
9.
10. HAEMANGIOPERICYTOMA
● Vascular origin
● Age group of 60-70 years
● Presents with epistaxis
● Arises from the pericyte-a cell surrounding the
capillaries
● TREATMENT - Wide surgical excision
12. PLASMACYTOMA
● Predominantly affects males over 40 years
● TREATMENT - By radiotherapy followed 3
months later by surgery if regression does
not occur
15. BENIGN NEOPLASMS
● OSTEOMAS - Commonly seen in frontal sinus
● FIBROUS DYSPLASIA - Medullary bone is
replaced by fibrous tissue resulting in distortion
and expansion of bone.
● OSSIFYING FIBROMA - Seen in young adults.The
tumor can be shelled out easily.
● AMELOBLASTOMA - Arises fromodontogenic
tissue
16. MALIGNANT NEOPLASMS OF PNS
MAXILARY SINUS CARCINOMA :
Clinical features
❖ Early features - Nasal stuffiness,blood stained nasal
discharge,facial pain,epiphora
❖ Late features - will depend on direction of spread and extent
of growth.
18. INFERIOR SPREAD
● Expansion of alveolus with dental pain
● Loosening of teeth,poor fitting of dentatures
● Swelling in hard palate or alveolus.
SUPERIOR SPREAD
● Proptosis
● Diplopia
● Ocular pain
19. POSTERIOR SPREAD
● Into pterygomaxillary fossa
● Muscles causing trismus
● Nasopharynx,sphenoid sinus and base of skull
INTRACRANIAL SPREAD
● Occur through ethmoids,cribriform plate or foramen lacerum
LYMPHATIC SPREAD
● Submandibular and upper jugular nodes are enlarged
● Nodal metastasis is umcommon
20. DIAGNOSIS
● Diagnostic nasal endoscopy
● X-ray PNS : Expansion and destruction of bony wall
● CT scan PNS : with contrast
● Biopsy
23. OHNGREN’S LINE : An imaginary plane extending between
medial canthus of eye and angle of mandible.
Supra structural growths situated above this plane have a poorer
prognosis
Infra structural growths situated below this plane have better
prognosis
24. AJCC CLASSIFICATION
American Joint Committee on Cancer Classification
Histopathologically Squamous cell carcinoma is classified
further into :
● Well differentiated
● Moderately differentiated
● Poorly differentiated
27. LEDERMAN’S CLASSIFICATION
2 horizontal lines of Sebileau pass through floors of orbits and
maxillary sinus ,producing :
● SUPRASTRUCTURE : ethmoid,sphenoid and frontal sinuses;
olfactory area of nose
● MESOSTRUCTURE : maxillary sinus and respiratory part of nose
● INFRASTRUCTURE : alveolar process
28. TREATMENT
To decide the line of treatment,following factors help ;
➔ Nature of malignancy (Histologically)
➔ Location of disease
➔ Extent of disease
29. ● Early cases (stage 1 and 2 SCC) -- surgery or radiation
● T3 and T4 Lesions --- combined modalities of radiation and
surgery
● Nowadays 3 dimensional conformal radiotherapy and
intensity modulated techniques are used
● Chemoradiation is also been used for large tumors.
30. MAXILLECTOMY
● Incision used -
Weber Fergusson’s icision
● Lateral rhinotomy incision
with horizontal infraorbital
component and midline lip
slit.
➔ Orbital evaluation
➔ Rehabilitation - Maxillary
prosthesis and artificial eye
31. CHEMORADIATION
● Chemotherapy and radiation have been used together for
large and inoperable tumors.
● Intra-arterial infusion :
○ 5-Fu or Cisplatin
○ 5-Fu with radiation
have also been used.
32. ETHMOID SINUS MALIGNANCY
CLINICAL FEATURES:
● Early features - nasal obstruction,blood stained nasal discharge and retro
orbital pain
● Late features - broadening of nasal root,lateral displacement of eye ball,
diplopia,meningitis.
● Nodal involvement is not common.Upper nodes may be involved.
TREATMENT:
Craniofacial resection
34. FRONTAL SINUS MALIGNANCY
CLINICAL FEATURES
● Pain and swelling of frontal region
● Swelling above medial canthus
● Growth may extend into orbit
TREATMENT
Preoperative radiation followed by surgery
-Frontal sinusotomy with ethmoid and orbital exenteration
-Neurosurgical approach
35. SPHENOID SINUS MALIGNANCY
● Primary malignancy is rare
● Plain X-rays, CT scan and biopsy through sphenoidotomy are
essential.
TREATMENT
Radiotherapy is the mainstay treatment.
