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Nasal obstruction
This document discusses differential diagnoses of nasal obstruction and neoplasms of the nose and paranasal sinuses. It provides a list of structural, infectious, allergic and other causes of unilateral and bilateral nasal obstruction. It also classifies benign and malignant nasal tumors and describes the presentation, diagnosis and treatment of inverted papilloma and sinonasal carcinomas such as maxillary sinus carcinoma. The treatment of maxillary sinus carcinoma includes surgery such as total maxillectomy with options like orbital exenteration or anterior cranio-facial resection depending on tumor extent.
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Nasal obstruction
- 1. Dr. Ramesh Parajuli,MS Chitwanmedical college teaching hospital, bharatpur-10,chitwan Nepal Differential Dx of nasal obstruction & Neoplasms of Nose and PNS
- 5. Differential diagnosis ofnasal obstruction 1.Structural: DNS, inf.turbinate hypertrophy,concha bullosa 2.Infection: Unilateral sinusitis 3.Polyp: Antrochoanal polyp 4.FB 5.Neoplasms 6.Congenital:choanal atresia 7.Trauma 8.Granulomatous Dx:Rhinoscleroma 1.Infection: -Acute rhinitis -CRS, Atrophic rhinitis 2.Allergy:Allergic rhinitis 3.Non allergic,non infective: Vasomotor rhinitis 4.Adenoid hypertrophy 5.Structural: DNS 6.Trauma:Septal hematoma 7. Ethmoidal polyposis 8.Neoplasms 9.Rhinitis medicamentosa Causes of unilateral nasal obstruction Causes of Bilateral Nasal obstruction
- 10. Neoplasms of Noseand PNS Benign 1. Papilloma 2. Ossifying Fibroma 3. Osteoma 4. Haemangioma 5. Neurofibroma Intermediate Inverted papilloma Malignant 1. Squamous cell carcinoma 2. Adenocarcinoma 3. Anaplastic carcinoma 4. Transitional cell carcinoma 5. Malignant melanoma 6. Salivary gland tumours 7. Rhabdomyosarcoma Classification
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- 12. Normal medullary boneis replaced by abnormal proliferation of fibrous tissue, resulting in distortion & expansion of bone C.T. scan: ground - glass appearance Treatment: complete surgical excision Fibrous dysplasia
- 14. •Locally aggressive sino-nasaltumour •Synonyms: Ringertz or Schneiderian papilloma •Common in males between 50-70 years •It arises from the lateral wall of nose •Presents as unilateral, friable, pink mass •Diagnosis made by punch biopsy Inverted papilloma
- 15. Treatment: •Medial maxillectomy (ðmoidectomy)by lateral rhinotomy approach •Tendency to recur after surgical removal •Squamous cell ca is present in 1015% cases •Radiotherapy is avoided
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- 17. Epidemiology •Maxillary sinus>ethmoid>frontal>sphenoid •>80% aresquamous cell carcinoma •Male : female = 2:1 •Commonly seen in 45-60 years Sinonasal malignancy
- 18. 1. Hardwood dust(adenocarcinoma) 2. Softwood dust (squamous carcinoma) 3. Nickel refining; chromium workers 4. Boot, shoe and textile workers 5. Mustard gas exposure 6. Human papilloma virus Risk factors
- 19. Carcinoma Maxillary Sinus(Maxilla) Earlysymptoms •Mimic maxillary sinusitis •Nasal blockage •Blood-stained nasal discharge •Facial paraesthesia or pain •Epiphora
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- 21. Medial spread: Unilateral nasalobstruction Unilateral purulent nasal discharge Epistaxis Unilateral, friable, nasal mass Anterior spread: Cheek swelling Invasion of facial skin Late Clinical features Inferior spread: Expansion of alveolus with dental pain Loosening of teeth, poor fitting of dentures Swelling in hard palate or alveolus Superior spread: Proptosis Diplopia Ocular pain
- 22. Posterior spread: Pterygoid muscleinvolvement trismus Intracranial spread via: Ethmoids, cribriform plate or foramen lacerum Lymphatic spread: Neck node metastases in late stages Systemic spread: Lungs, bone
- 23. Initial presentation 7months 11 months
- 24. Diagnostic nasal endoscopy C.T.Scan Nose & Paranasal sinus: expansion & destruction of bony wall Biopsy Diagnosis
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- 28. TNM Staging T1 =Tumor confined to antral mucosa T2 = Bone destruction of hard palate / middle meatus T3 = Involvement of skin of cheek, floor or medial wall of orbit, ethmoid sinus, posterior antral wall, pterygoid plates, infratemporal fossa T4 = Involvement of orbital contents, cribriform plate, frontal or sphenoid sinus, skull base, nasopharynx
- 29. Treatment • T1 &T2 = Surgery or Radiotherapy • T3 = Surgery + Radiotherapy • T4 = Surgery + Radiotherapy + Chemotherapy • Surgery post-operative Radiotherapy after 4-6 weeks
- 30. Surgical Options 1.Total maxillectomy: WeberFergusson incision Malignancy limited to maxilla 2.Radical maxillectomy (with orbital exenteration): Involvement of orbital fat 3. Anterior Cranio-Facial Resection: Involvement of cribriform plate, frontal sinus
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- 33. Total maxillectomy done& incision closed
- 34. Palatal defect &prosthesis
- 35. Orbital exenteration indications •Involvement of orbital apex • Involvement of extra-ocular muscles • Involvement of bulbar conjunctiva or sclera • Lid involvement beyond a reasonable hope for reconstruction • Non-resectable full thickness invasion through periorbita into retrobulbar fat
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- 37. Post-operative defect &prosthesis
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