The maxillary sinus is the largest and most commonly involved sinus in malignancies. Maxillary sinus carcinoma arises from the sinus lining and spreads locally through bone destruction and invasion of surrounding structures. Distant metastases occasionally occur in the lungs. Diagnosis involves radiography, CT scan, and biopsy. Treatment depends on tumor stage and may involve surgery, radiation therapy, or chemoradiation. Prognosis diminishes with increased stage, with a 5-year survival rate of 40-50% even with advances in multimodal therapy.

1. MAXILLARY SINUS CARCINOMA

2. ANATOMY
ANTRUM OF HIGHMORE

3. IMPORTANCE OF THIS SINUS...??
 Largest sinus.
 Most frequent PNS involved in malignancies.
 Very difficult to treat:
Close anatomical proximity to the vital
structures.
Complete surgical resection is challenging.
Remain asymptomatic for a long time.

4. MALIGNANT NEOPLASMS
 CA nose & PNS constitute 0.44% of all malignancies in India.
 Frequency: Max.s > Ethm.s > Frontal.s >
Sphenoid.s
 AETIOLOGY:
 Nickel & chromium refineries(Sq.cell &Anaplastic CA).
 Mahogony wood industries(Adeno.CA).
 Leather tanning industries.
 Bantu tribe ofAfrica: use of stuff rich in Ni & Cr.

5. CA MAXILLARY SINUS
 Arises from lining of
Maxillary sinus.
 Middle aged males(40-
60yrs).
 Remain silent for a long time
or showing only symptoms of
sinusitis.
 Destroys bony walls and
invades the surrounding
structures.

6. CA MAXILLARY SINUS
 Clinical Features:
 Nasal stuffiness.
 Blood-stained nasal discharge.
 Facial paraesthesia or pain.
 Epiphora.
 These are early C/F
 Often misdiagnosed and
treated as Sinusitis.

7. Patterns of tumour spread.
 Anteriorly : cheek and skin.
 Posteriorly : pterygomaxillary fossa, pterygoid plates,
nasopharynx, sphenoid sinus, base of skull.
 Medially : nasal cavity, NLD.
 Superiorly : orbits, ethmoid sinuses.
 Inferiorly : palate, buccal sulcus.
 Intracranial : ethmoid and cribriform plates.
 Lymphatic : submandibular, upper jugular, retropharyngeal
nodes.
 Systemic : lungs occasionally.

8. DIAGNOSIS.
 Radiograph of the sinuses.
 Computerised tomography (CT) scan.
 Biopsy.

9. Axial Plane
Coronal Plane

10. CLASSIFICATION
 Ohngren’s Classification.
 AJCC (American Joint Committee on Cancer).
 Lederman’s Classification.

11. Ohngren’s Classification.
Suprastructure: poor
prognosis
Infrastructure: good
prognosis

12. AJCC CLASSIFICATION.

13. Lederman’s Classification.
Ethmoid, sphenoid, frontal
sinuses & olfactory area of
nose.
Maxillary & respiratory
part of nose.
Alveolar process

14. TNM Classification and Staging.
Tumour (T).
T1 - tumour limited to maxillary sinus mucosa with no erosion.
T2 - bony erosion, extension into hard palate, nasal meatus,
except the posterior wall.
T3 - invading posterior wall, subcutaneous tissue, floor/medial wall
of orbit, pterygoid fossa, ethmoid sinus.
T4a - ant.orbit, skin of cheek, pterygoid plates, cribriform plates,
sphenoid, frontal sinus.
T4b - orbital apex, dura, brain, middle cranial fossa, nasopharynx,
cranial nerves other than maxillary division of
Trigeminal (V2).

15. Regional Lymph Node (N).
Nx - regional lymph nodes cannot be assessed.
No - no regional lymph node metastasis.
N1 - metastasis in single ipsilateral lymph nodes, not less than
3cms.
N2a - single ipsilateral < 6cms.
N2b - multiple ipsilateral < 6cms.
N2c - bilateral < 6cms.
N3 - lymph node > 6cms.

16. Distant Metastasis (M).
Mx - Distant metastasis cannot be assessed.
Mo - No distant metastasis.
M1 - Distant metastasis.

17. TREATMENT
 Stage 1 & 2 SCC Surgery or Radiation.
 Stage 3 & 4 SCC Combined modalities.
 Inoperable tumours Chemoradiation.
 intra arterial infusion of 5-Fluorouracil or Cisplatin.

18. WEBER-FERGUSSON’S INCISION

19. PROGNOSIS
 Survival diminishes with stage of tumour.
 5 yr survival 40-50%
 Advances are being made in multimodal therapy with
improved Radiation delivery with a hope to improve
results.

20. SUMMARY
1. ANATOMYAND RELATION.
2. INCIDENCEAND ETIOLOGY.
3. CLINICAL FEATURES.
4. SPREAD OFTUMOUR.
5. DIAGNOSIS.
6. CLASSIFICATION.
7. CLINICAL STAGING.
8. TREATMENTAND PROGNOSIS.

21. Thank U...