The document discusses neoplasms of the nose and paranasal sinuses. It describes the anatomy and types of tissues that can be involved. Both benign and malignant tumors are discussed. For benign tumors, inverted papilloma, angiofibroma, hemangioma, osteoma and fibrous dysplasia are summarized. For malignant tumors, carcinomas of the maxillary, ethmoid and frontal sinuses are summarized including presentation, classification, staging and treatment approaches. Other rare malignant tumors discussed include malignant melanoma and olfactory neuroblastoma.

2. NEOPLASMS OF NOSE AND
PARANASAL SINUSES

4. ANATOMY OF NOSE AND PARANASAL
SINUSES

6. TYPE OF TISSUES
Tumors can arise from any one or more type of tissue
present in nose and paranasal sinuses
• Epithelial tissue
Anterior to vestibule –keratinized stratified squamous
epithelium
Posterior to vestibule + PNS–pseudostratified ciliated
columnar epithelium
• Bone
• Cartilage
• Muscle
• Vascular tissue
• Lymphoid tissue
• Nerves

7. NEOPLASMS OF NOSE AND
PARANASAL SINUSES
• Very rare 3%
• Delay in diagnosis because of similarity to
benign conditions
• Predominately in older males

8. AETIOLOGY
• Smoking
• Nickel refining processes
• Leather tanning
• Hardwood exposure
• Human papilloma virus (HPV 6,11,16 and 18)
HPV 16 and 18 are mostly associated with
malignant transformation in inverted papilloma

9. LOCATIONS
• Maxillary sinus:
70%
• Ethmoid sinus:
30%
• Sphenoid sinus:
3%
• Frontal sinus:
1%

10. PRESENTATION
• Nasal findings: 50%
obstruction,epistaxis,rhinnorhae
• Oral symptoms:25-35%
Pain,trismus,erosion,alveolar ridge fullness
• Ocular findings:25%
Epiphora,diplopia,proptosis
• Facial signs:
Paresthesia,asymmetry

11. EPITHELIAL
MESENCHYMAL
NEURAL
FIBRO-OSSEUS
VASULAR
LYMPHATIC
ODONTOGENIC

12. BENIGN NEOPLASMS

13. INVERTED PAPILLOMA
• Also called transitional cell papilloma or ringertz
tumor or schneiderian papilloma)
• 4% of sinonasal tumors.
• More common in men of age 40 to 70
• Site of Origin: lateral nasal wall
• Human papilloma virus
• Unilateral
• Malignant Transformation in 10-15%
patients(SCC)

14. INVERTED PAPILLOMA

16. RESSECTION
• Initially via transnasal resection / polypectomy
50-80% recurrence
• Medial Maxillectomy via lateral rhinotomy
Gold Standard
10-20%
• Endoscopic medial maxillectomy
Key concepts:
 Identify the origin of the papilloma
 Bony removal of this region
 Recurrence rate 11-12%

17. ANGIOFIBROMA
(Juvenile Nasopharygeal)
• Rare but locally aggressive vascular
lesion
• Almost exclusively in young
teenage boys(in 2nd decade of life)
• Thought to be testosterone
dependent
• Site of origin: sphenopalatine
foramen
• Clinical features :
 Progressive nasal obstruction
 Epistaxis
• Treatment:
Surgical excision according to stage
Radiation

18. LATERAL RHINOTOMY &
MEDIAL MAXILLECTOMY

19. HAEMANGIOMA
Presents with recurrent
epistaxis.
Local excision is performed
• Capillary haemangioma
Anterior part of nasal
septum
• Cavernous haemangioma
Turbinates on the lateral
wall of nose

20. OSTEOMA
• 15 to 40 years
• Frontal > Ethmoid > Maxillary
• Slow-growing bone tumour &
often remains asymptomatic.
• It can cause
obstruction of ostium
 mucocele formation
 pressure symptons
• Rx :Local excision

21. FIBROUS DYSPLASIA
• Bone replaced by Fibrous tissue
• Maxilla > Ethmoids & Frontal
• Clinical Features:
 Disfigurement of Face
 Nasal Obstruction
 Displacement of eyes
• Radiology:
Diffuse margins with Ground glass
appearance
• Rx - Cosmetic restructuring surgery

22. FIBROUS DYSPLASIA
Axial CT shows radiopaque mass
obliterating maxillary sinus and
Nasal cavity on the right side

23. AMELOBLASTOMA
(ADAMANTINOMA)
• Arises from odontogenic tissue
• Locally aggressive
• Invades maxillary sinus
• Rx :surgical excision

24. INTRANASAL
MENINGIOENCEPHLOCELE
• Herniation of brain tissues and
meninges through foramen
caecum or cribriform plate.
• Smooth polyp like mass between
upper part of nose and middle
turbinate.
• Increases on crying or straining.
• CT scan for skull base defect
• Treatment : Frontal craniotomy
for severing the brain salk and
udra nd bone repair.

25. MALIGNANT NEOPLASMS

26. CA MAXILLARY SINUS
• Arises from the lining of
maxillary sinus.
• Middle aged males(40 -
60yrs)
• Remain silent for a long
time or showing only
symptoms of sinusitis
• Late :destroy bony walls &
invades into surrounding
structures.

27. CA MAXILLARY SINUS
Clinical Features
• Nasal Stuffiness
• Blood stained Nasal discharge
• Parasthesia or pain over cheek
• Epiphora
These are early Clinical Feature.
Often misdiagnosed and treated as sinusitis.

28. CA MAXILLARY SINUS
DIAGNOSIS:
• X-ray PNS.
• CT Scan of PNS
(Coronal & Axial).
• Biopsy - Nasal
Mass / Endoscopic.

29. CA MAXILLARY SINUS-classification
• OHNGREN’s Classification
• AJCC Classification (only for SCC)
• Lederman’s Classification

30. CA MAXILLARY SINUS-classification
• OHNGREN’s
Classification
• Imaginary plane drawn
b/w medial canthus of
eye & the angle of
mandible
• Lesion above this :
suprastuctural-poor
prognosis
• Lesion below this :
infrastructural- better
prognosis

31. • Lederman’s Classification

32. TNM staging of Ca maxillary sinus

34. MAXILLARY SINUS MALIGNANCY
• TREATMENT
For SCC, combination of
radiotherapy and surgery
is the choice.
• Surgery
 Total Maxillectomy
 Partial Maxillectomy
• PROGNOSIS
5yrs survival rate is 30%

35. TREATMENT

36. ETHMOID SINUS MALIGNANCY
• Primary lesion is not common in ethmoid sinus
• Occur as an extension from maxillary sinus growth
• Clinical features :
 Nasal obstruction
 Blood stained nasal discharge
 Retro orbital pain
 Lateral displacement of eye & diplopia
 Intracranial spread can cause meningitis
• Rx :Pre operative radiation + Total ethmoidectomy
• Prognosis : 5yrs survival rate is 30%

37. FRONTAL SINUS MALIGNANCY
• Uncommon
• 40-50 yrs age group ; males
more
• Clinical Features :
 Pain & Swelling in frontal
region
 Growth can go post to ant
cranial fossa
 Growth can extent through
the ethmoids into orbit
• Rx : Pre operative radiation
+ Frontal sinusectomy

38. MALIGNANT MELANOMA
• Rare mucosal melanomas
occurring within the nasal cavity
• More common in elderly
females
• Bluish black polypoidal mass
• Locally aggressive with multiple
distant metastases
• Treatment
 Surgical Resection
Chemoradiation is avoided

39. OLFACTORY NEUROBLASTOMA
• Arise from olfactory epithelium
• Often presented late with intraranial
extension
• Treatment
Craniofacial resection
Adjuvant radiotherapy