This document discusses tumors of the nose and paranasal sinuses. It begins by classifying inverted papilloma, a benign neoplasm originating from the Schneiderian membrane. Inverted papilloma commonly presents in males aged 40-70 as a unilateral polypoidal mass in the lateral nasal wall. It has a tendency to recur after surgery and is associated with squamous cell carcinoma in 10-15% of cases. The document then discusses clinical features, imaging findings, and treatment options for various tumors including hemangioma, osteoma, fibrous dysplasia, and malignant tumors like squamous cell carcinoma and adenocarcinoma. Risk factors, routes of spread, and clinical manifestations are described for malignant tumors

1. TUMORS OF NOSE AND PARANASAL
SINUS

2. CLASSIFICATION

3. INVERTED PAPILLOMA
Benign neoplasm
Schneiderian membrane-neuro-ectodermal origin
Conrad Victor Schneider
Accounts for 5% of all benign tumors
Schneiderian papilloma
Ringertz tumor
Transitional cell papilloma

4. Inverted papilloma
microscopically 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

5. Inverted papilloma
Greyish 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

6. CLINICAL FEATURES
U/L NASAL OBSTRUCTION
BLEEDING FROM THE NOSE
U/L NASAL MASS RESEMBLING A POLYP
KROUSE STAGING

7. CT SCAN
Bone erosion, thinning,
remodelling, sclerosis.
hyperdense areas with linear
calcification

8. TREATMENT
MEDIAL MAXILLECTOMY- Endoscopic/External
Lateral Rhinotomy by MOURE’S incision

11. 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

12. osteoma Fibrous dysplasia
Mc 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

14. Malignant tumors

15. EPIDEMIOLOGY
Incidence - 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 % )

16. Malignancy of PNS
Maxillary sinus most commonly involved
Followed by ethmoid and frontal sinus
Squamous cell carcinoma –most common histological type
Adenocarcinoma –common in wood workers

17. Risk factors
Inhalation of carcinogens – 40%
Hardwood dust (adenocarcinoma) – 70 times risk
Softwood dust (squamous carcinoma)
Nickel refining (250 times); chromium workers
Boot , shoe & textile workers
Isopropyl oil, volatile hydrocarbons & mustard gas
Thorotrast dye injection
Snuff

18. Routes of spread

19. Clinical features
Oral symptoms
Nasal symptoms
Orbital symptoms
Facial symptoms
CNS symtoms

20. ORAL SYMTOMS
Due 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

21. Nasal symptoms
Due to medial spread
Seen 45-75% patients
u/l nasal obstruction
u/l nasal discharge-blood stained

22. Orbital symptoms
Due to superior spread
Seen 25% of patients
Lid swelling,epiphora
Diplopia , proptosis, impaired vision

23. Facial symptoms
Seen 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

24. 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)

25. INVESTIGATIONS
DNE AND BIOPSY
CECT SCAN

26. Ohngren’s line

27. Lederman staging

30. Treatment
Surgery-total maxillectomy
Surgery+radiotherapy
Sandwich therapy
Radiotherapy …..Surgery…..Radiotherapy

31. Weber Ferguson incision

33. Thank you