SlideShare a Scribd company logo
Neoplasms of Nose and PNS
Dr. Krishna Koirala
2019-12-30
Classification
• Benign
–Everted papilloma
–Osteoma
–Chondroma
–Ossifying Fibroma
–Hemangioma
• Intermediate
– Inverted papilloma
– Hemangiopericytoma
– Oncocytoma
• Malignant
− Squamous cell carcinoma
− Basal cell carcinoma
− Adenocarcinoma
− Sarcomas
− Undifferentiated carcinoma
− Malignant melanoma
− Minor salivary gland tumors
Osteoma
• Common incidental finding in sinus x-rays
• Most common in frontal sinus
• Mostly asymptomatic and do not grow
• Surgery required for symptomatic osteomas or
those that rapidly increase in size
• Complete removal of tumor with its base - done by
bicoronal osteoplastic flap technique
Frontal sinus osteoma
Bicoronal osteoplastic flap
Osteoma exposed
Tumor removal and closure of bone flap
Ossifying fibroma (Fibrous dysplasia)
• Normal medullary bone replaced by abnormal
proliferation of fibrous tissue, resulting in distortion
and expansion of bone
• C.T. scan : ground - glass appearance with regions of
osteolysis and calcification
• Treatment : complete surgical excision
• Recurrence common
Ossifying fibroma
Inverted papilloma
• Locally aggressive intermediate sino-
nasal tumour
• Synonyms: Ringertz tumor, Schneiderian
papilloma , Cylindrical cell papilloma
• Common in males between 50-70 years
• Arises from the lateral wall of nose
• Presents as unilateral, friable, leaf like
fleshy mass arising from middle meatus
• Diagnosis : tissue biopsy
C.T. scan Nose and P.N.S. Contrast coronal
cuts
• Intra-nasal and maxillary
mass with opacification of
maxillary and ethmoid
sinuses
• Bone destruction of lateral
nasal wall
H.P.E. : Inward invasion of hyperplastic epithelium
into underlying stroma
• Treatment:
− Medial maxillectomy and en bloc ethmoidectomy by lateral
rhinotomy or midfacial degloving approach is the standard
• Squamous cell ca present in 10 -15% cases
• Radiotherapy is avoided
• Marked tendency to recur after surgical removal
− 80% after intrananasal removal
− 60% after Caldwell –Luc surgery
− 30% after medial maxillectomy
Moure’s lateral rhinotomy
Osteotomy cuts
Bone removal and & tumor exposure
Tumour removed and incision closed
Midfacial degloving approach
Malignant tumors
Epidemiology
• O.5% of all body cancers
• 15% of all Head and Neck malignancies
• Maxillary sinus is the most common
• Squamous cell carcinoma : 80-85%
• Adenocarcinoma common in ethmoid
• Male : female = 2:1
• Common age group : 45-60 years
Risk factors
• Hardwood dust (adenocarcinoma)
• Softwood dust (squamous cell carcinoma)
• Nickel refining; chromium workers
• Boot, shoe and textile workers
• Mustard gas exposure
• Human papilloma virus ??
Carcinoma of Maxilla
Early Clinical features
• Mimics maxillary sinusitis
− Nasal stuffiness
− Blood-stained nasal discharge
− Facial paraesthesia or pain
− Epiphora
Spread
Late clinical features
• Medial spread
− Unilateral nasal obstruction
− Unilateral purulent nasal discharge
− Epistaxis
− Unilateral, friable, nasal mass
• Anterior spread
− Cheek swelling
− Invasion of facial skin
• 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
• Posterior spread
− Pterygoid muscle involvement  trismus
• Intracranial spread
− Via Ethmoid, cribriform plate or foramen lacerum
• Lymphatic spread
− Neck node metastases in late stages
• Systemic spread
− Lungs, bone ,liver
Diagnosis
• Diagnostic nasal endoscopy
• X-ray paranasal sinus : Expansion and destruction of
bony wall
• C.T. Scan axial & coronal cuts with contrast
• Biopsy
Classification
• Ohngren's Classification
– 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
• Lederman’s Classification
− 2 horizontal lines of Sebileau pass through floors
of orbits & maxillary sinus, producing
− Suprastructure : Ethmoid, sphenoid & frontal
sinuses; olfactory area of nose
− Mesostructure : maxillary sinus & respiratory
part of nose
− Infrastructure: alveolar process
T.N.M. 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
Treatment options
• T1 /T2 : Surgery or Radiotherapy
• T3 : Surgery + Radiotherapy
• T4 : Surgery + Radiotherapy +Chemotherapy
− Europeans: Pre-operative Radiotherapy (5000-6500
c Gy)  surgery after 4-6 weeks
− Americans: Surgery  post-operative Radiotherapy
after 4-6 weeks
Surgical Options
• Total maxillectomy (Weber Fergusson incision)
− Malignancy limited to maxilla
• Radical maxillectomy with orbital exenteretion (Weber
Fergusson Diffenbach incision)
− Involvement of orbital fat
• Anterior Cranio Facial Resection (extended lateral
rhinotomy incision)
− Involvement of cribriform plate, frontal sinus
Total Maxillectomy
Tarsorrhaphy
Weber Fergusson incision
Osteotomy cuts
Total maxillectomy done and incision closed
Palatal defect and prosthesis
Indications of orbital exenteretion
• 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
Orbital exenteration
Post-operative defect and prosthesis
Cranio-facial resection
• Lateral rhinotomy incision combined with midline
forehead incision

More Related Content

What's hot

Vestibular schwannoma and glomus tumors
Vestibular schwannoma  and glomus tumorsVestibular schwannoma  and glomus tumors
Vestibular schwannoma and glomus tumors
krishnakoirala4
 
Angiofibroma
AngiofibromaAngiofibroma
Angiofibroma
krishnakoirala4
 
2. conditions of the nasal septum
2. conditions  of the  nasal septum2. conditions  of the  nasal septum
2. conditions of the nasal septum
krishnakoirala4
 
15. complications of csom kk
15. complications of csom kk15. complications of csom kk
15. complications of csom kk
krishnakoirala4
 
Trauma to the face
Trauma to the faceTrauma to the face
Trauma to the face
Jenan M
 
Facial trauma and neck trauma
Facial trauma and neck traumaFacial trauma and neck trauma
Facial trauma and neck trauma
EM OMSB
 
Trauma to the face
Trauma to the faceTrauma to the face
Trauma to the face
Jinu Iype
 
Nasopharyngeal carcinoma
Nasopharyngeal carcinomaNasopharyngeal carcinoma
Nasopharyngeal carcinoma
krishnakoirala4
 
Head and Neck Trauma by Dr. Kenneth Dickie
Head and Neck Trauma by Dr. Kenneth DickieHead and Neck Trauma by Dr. Kenneth Dickie
Head and Neck Trauma by Dr. Kenneth Dickie
Kenneth Dickie
 
9 managegement of maxillofacial injuries
9 managegement of maxillofacial injuries9 managegement of maxillofacial injuries
9 managegement of maxillofacial injuriesEphrem Tamiru
 
Nasal fracture revised
Nasal fracture revisedNasal fracture revised
Nasal fracture revised
Arsenic Halcyon
 
Maxillofacial trauma
Maxillofacial traumaMaxillofacial trauma
Maxillofacial traumaUE
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
krishnakoirala4
 
Surgical mx of otosclerosis
Surgical mx of otosclerosisSurgical mx of otosclerosis
Surgical mx of otosclerosis
Sanjay Maharjan
 
Aural atresia regional conference
Aural atresia regional conferenceAural atresia regional conference
Aural atresia regional conference
ENT Resident
 
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...Maxillofacial trauma evaluation and management (nx power lite) /certified fix...
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...
Indian dental academy
 

What's hot (18)

Vestibular schwannoma and glomus tumors
Vestibular schwannoma  and glomus tumorsVestibular schwannoma  and glomus tumors
Vestibular schwannoma and glomus tumors
 
Angiofibroma
AngiofibromaAngiofibroma
Angiofibroma
 
2. conditions of the nasal septum
2. conditions  of the  nasal septum2. conditions  of the  nasal septum
2. conditions of the nasal septum
 
15. complications of csom kk
15. complications of csom kk15. complications of csom kk
15. complications of csom kk
 
Trauma to the face
Trauma to the faceTrauma to the face
Trauma to the face
 
Facial trauma and neck trauma
Facial trauma and neck traumaFacial trauma and neck trauma
Facial trauma and neck trauma
 
Trauma to the face
Trauma to the faceTrauma to the face
Trauma to the face
 
Nasopharyngeal carcinoma
Nasopharyngeal carcinomaNasopharyngeal carcinoma
Nasopharyngeal carcinoma
 
Head and Neck Trauma by Dr. Kenneth Dickie
Head and Neck Trauma by Dr. Kenneth DickieHead and Neck Trauma by Dr. Kenneth Dickie
Head and Neck Trauma by Dr. Kenneth Dickie
 
9 managegement of maxillofacial injuries
9 managegement of maxillofacial injuries9 managegement of maxillofacial injuries
9 managegement of maxillofacial injuries
 
Nasal fracture revised
Nasal fracture revisedNasal fracture revised
Nasal fracture revised
 
Face Eye Trauma
Face Eye TraumaFace Eye Trauma
Face Eye Trauma
 
Maxillofacial trauma
Maxillofacial traumaMaxillofacial trauma
Maxillofacial trauma
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Surgical mx of otosclerosis
Surgical mx of otosclerosisSurgical mx of otosclerosis
Surgical mx of otosclerosis
 
Aural atresia regional conference
Aural atresia regional conferenceAural atresia regional conference
Aural atresia regional conference
 
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...Maxillofacial trauma evaluation and management (nx power lite) /certified fix...
Maxillofacial trauma evaluation and management (nx power lite) /certified fix...
 
Surgical treatment chronic sinusitis
Surgical treatment chronic sinusitisSurgical treatment chronic sinusitis
Surgical treatment chronic sinusitis
 

Similar to Neoplasms of nose and pns

malignant sinonasal tumors+management.pptx
malignant sinonasal tumors+management.pptxmalignant sinonasal tumors+management.pptx
malignant sinonasal tumors+management.pptx
EmanZayed17
 
TUMORS OF EAR
TUMORS OF EARTUMORS OF EAR
TUMORS OF EAR
KaushalSharma124
 
Sinonasal Tumours - Okoye
Sinonasal Tumours - OkoyeSinonasal Tumours - Okoye
Sinonasal Tumours - Okoye
Chukwuma-Ikem Okoye
 
COMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdf
COMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdfCOMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdf
COMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdf
Eden University
 
Sinonasal tumors dr rk
Sinonasal tumors dr rkSinonasal tumors dr rk
Sinonasal tumors dr rk
raju kafle
 
Tumours of Ear
Tumours of EarTumours of Ear
Tumours of Ear
Anwaaar
 
Paranasal sinuses carcinoma
Paranasal sinuses carcinomaParanasal sinuses carcinoma
Paranasal sinuses carcinoma
Venkatesan Amirthalingam
 
Tumours of external and middle ear
Tumours of external and middle earTumours of external and middle ear
Tumours of external and middle ear
Ramesh Parajuli
 
Ear carcinoma
Ear carcinomaEar carcinoma
Ear carcinoma
DrAyush Garg
 
Tumours of External Auditory Canal and Middle Ear
Tumours of External Auditory Canal and Middle EarTumours of External Auditory Canal and Middle Ear
Tumours of External Auditory Canal and Middle Ear
Dr Harjitpal Singh
 
Carcinoma maxilla.pptx
Carcinoma maxilla.pptxCarcinoma maxilla.pptx
Carcinoma maxilla.pptx
gracydavid1105
 
Malignant tumors involving paranasal sinuses
Malignant tumors involving paranasal sinusesMalignant tumors involving paranasal sinuses
Malignant tumors involving paranasal sinuses
Balasubramanian Thiagarajan
 
Parapharyngeal space tumours
Parapharyngeal space tumoursParapharyngeal space tumours
Parapharyngeal space tumoursDr./ Ihab Samy
 
Diseases of the Ear.pptx
Diseases of the  Ear.pptxDiseases of the  Ear.pptx
Diseases of the Ear.pptx
PaulosEshetu1
 
Radiation oncology in ent- Dr santhosh,ENT -vizag
Radiation oncology in ent- Dr santhosh,ENT -vizagRadiation oncology in ent- Dr santhosh,ENT -vizag
Radiation oncology in ent- Dr santhosh,ENT -vizag
Santhoshbabuslides
 
Sch.36 surgical management of sphenoid wing meningioma
Sch.36 surgical management of sphenoid wing meningiomaSch.36 surgical management of sphenoid wing meningioma
Sch.36 surgical management of sphenoid wing meningioma
Neurosurgery Vajira
 
Sch.32 surgical management of parasagittal and convexity meningioma
Sch.32 surgical management of parasagittal and convexity meningiomaSch.32 surgical management of parasagittal and convexity meningioma
Sch.32 surgical management of parasagittal and convexity meningioma
Neurosurgery Vajira
 
Nose and PNS Carcinoma (for UNDERGRADUATES)
Nose and PNS Carcinoma (for UNDERGRADUATES)Nose and PNS Carcinoma (for UNDERGRADUATES)
Nose and PNS Carcinoma (for UNDERGRADUATES)
Syeda Shahid
 
Skin Ca revised 2023.ppt
Skin Ca revised 2023.pptSkin Ca revised 2023.ppt
Skin Ca revised 2023.ppt
MrbrownJackson
 
MALIGNANT TUMORS OF PARANASAL SINUSES
MALIGNANT TUMORS OF PARANASAL SINUSESMALIGNANT TUMORS OF PARANASAL SINUSES
MALIGNANT TUMORS OF PARANASAL SINUSES
Vinod M K
 

Similar to Neoplasms of nose and pns (20)

malignant sinonasal tumors+management.pptx
malignant sinonasal tumors+management.pptxmalignant sinonasal tumors+management.pptx
malignant sinonasal tumors+management.pptx
 
TUMORS OF EAR
TUMORS OF EARTUMORS OF EAR
TUMORS OF EAR
 
Sinonasal Tumours - Okoye
Sinonasal Tumours - OkoyeSinonasal Tumours - Okoye
Sinonasal Tumours - Okoye
 
COMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdf
COMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdfCOMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdf
COMMON TUMORS IN ENT BY LOVENESS ULUNJI CHAWINGA.pdf
 
Sinonasal tumors dr rk
Sinonasal tumors dr rkSinonasal tumors dr rk
Sinonasal tumors dr rk
 
Tumours of Ear
Tumours of EarTumours of Ear
Tumours of Ear
 
Paranasal sinuses carcinoma
Paranasal sinuses carcinomaParanasal sinuses carcinoma
Paranasal sinuses carcinoma
 
Tumours of external and middle ear
Tumours of external and middle earTumours of external and middle ear
Tumours of external and middle ear
 
Ear carcinoma
Ear carcinomaEar carcinoma
Ear carcinoma
 
Tumours of External Auditory Canal and Middle Ear
Tumours of External Auditory Canal and Middle EarTumours of External Auditory Canal and Middle Ear
Tumours of External Auditory Canal and Middle Ear
 
Carcinoma maxilla.pptx
Carcinoma maxilla.pptxCarcinoma maxilla.pptx
Carcinoma maxilla.pptx
 
Malignant tumors involving paranasal sinuses
Malignant tumors involving paranasal sinusesMalignant tumors involving paranasal sinuses
Malignant tumors involving paranasal sinuses
 
Parapharyngeal space tumours
Parapharyngeal space tumoursParapharyngeal space tumours
Parapharyngeal space tumours
 
Diseases of the Ear.pptx
Diseases of the  Ear.pptxDiseases of the  Ear.pptx
Diseases of the Ear.pptx
 
Radiation oncology in ent- Dr santhosh,ENT -vizag
Radiation oncology in ent- Dr santhosh,ENT -vizagRadiation oncology in ent- Dr santhosh,ENT -vizag
Radiation oncology in ent- Dr santhosh,ENT -vizag
 
Sch.36 surgical management of sphenoid wing meningioma
Sch.36 surgical management of sphenoid wing meningiomaSch.36 surgical management of sphenoid wing meningioma
Sch.36 surgical management of sphenoid wing meningioma
 
Sch.32 surgical management of parasagittal and convexity meningioma
Sch.32 surgical management of parasagittal and convexity meningiomaSch.32 surgical management of parasagittal and convexity meningioma
Sch.32 surgical management of parasagittal and convexity meningioma
 
Nose and PNS Carcinoma (for UNDERGRADUATES)
Nose and PNS Carcinoma (for UNDERGRADUATES)Nose and PNS Carcinoma (for UNDERGRADUATES)
Nose and PNS Carcinoma (for UNDERGRADUATES)
 
Skin Ca revised 2023.ppt
Skin Ca revised 2023.pptSkin Ca revised 2023.ppt
Skin Ca revised 2023.ppt
 
MALIGNANT TUMORS OF PARANASAL SINUSES
MALIGNANT TUMORS OF PARANASAL SINUSESMALIGNANT TUMORS OF PARANASAL SINUSES
MALIGNANT TUMORS OF PARANASAL SINUSES
 

More from krishnakoirala4

Complications of csom
Complications of csomComplications of csom
Complications of csom
krishnakoirala4
 
Acute suppurative otitis media and and cortical mastoidectomy
Acute suppurative otitis media and  and cortical mastoidectomyAcute suppurative otitis media and  and cortical mastoidectomy
Acute suppurative otitis media and and cortical mastoidectomy
krishnakoirala4
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
krishnakoirala4
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
krishnakoirala4
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
krishnakoirala4
 
Neoplasms of nose and paranasal sinuses
Neoplasms of nose and paranasal sinuses Neoplasms of nose and paranasal sinuses
Neoplasms of nose and paranasal sinuses
krishnakoirala4
 
Nasopharyngeal carcinoma
Nasopharyngeal carcinomaNasopharyngeal carcinoma
Nasopharyngeal carcinoma
krishnakoirala4
 
Nasal polyps
Nasal polypsNasal polyps
Nasal polyps
krishnakoirala4
 
Epistaxis
EpistaxisEpistaxis
Epistaxis
krishnakoirala4
 
Deviated nasal septum and other septal conditions
Deviated nasal septum and other septal conditionsDeviated nasal septum and other septal conditions
Deviated nasal septum and other septal conditions
krishnakoirala4
 
Atrophic rhinitis
Atrophic rhinitisAtrophic rhinitis
Atrophic rhinitis
krishnakoirala4
 
Angiofibroma
AngiofibromaAngiofibroma
Angiofibroma
krishnakoirala4
 
Allergic and intrinsic rhinitis
Allergic and intrinsic rhinitisAllergic and intrinsic rhinitis
Allergic and intrinsic rhinitis
krishnakoirala4
 
Otosclerosis
OtosclerosisOtosclerosis
Otosclerosis
krishnakoirala4
 
Vestibular schwannoma and glomus tumors
Vestibular schwannoma and  glomus tumorsVestibular schwannoma and  glomus tumors
Vestibular schwannoma and glomus tumors
krishnakoirala4
 
Meniere's disease
Meniere's diseaseMeniere's disease
Meniere's disease
krishnakoirala4
 
Facial nerve palsy
Facial nerve palsyFacial nerve palsy
Facial nerve palsy
krishnakoirala4
 
Complications of csom
Complications of csomComplications of csom
Complications of csom
krishnakoirala4
 
Clinical features and diagnosis of rhinosinusitis
Clinical features and diagnosis of rhinosinusitisClinical features and diagnosis of rhinosinusitis
Clinical features and diagnosis of rhinosinusitis
krishnakoirala4
 
Obstructive sleep apnea syndrome
Obstructive sleep apnea syndromeObstructive sleep apnea syndrome
Obstructive sleep apnea syndrome
krishnakoirala4
 

More from krishnakoirala4 (20)

Complications of csom
Complications of csomComplications of csom
Complications of csom
 
Acute suppurative otitis media and and cortical mastoidectomy
Acute suppurative otitis media and  and cortical mastoidectomyAcute suppurative otitis media and  and cortical mastoidectomy
Acute suppurative otitis media and and cortical mastoidectomy
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Complications of sinusitis
Complications of sinusitisComplications of sinusitis
Complications of sinusitis
 
Neoplasms of nose and paranasal sinuses
Neoplasms of nose and paranasal sinuses Neoplasms of nose and paranasal sinuses
Neoplasms of nose and paranasal sinuses
 
Nasopharyngeal carcinoma
Nasopharyngeal carcinomaNasopharyngeal carcinoma
Nasopharyngeal carcinoma
 
Nasal polyps
Nasal polypsNasal polyps
Nasal polyps
 
Epistaxis
EpistaxisEpistaxis
Epistaxis
 
Deviated nasal septum and other septal conditions
Deviated nasal septum and other septal conditionsDeviated nasal septum and other septal conditions
Deviated nasal septum and other septal conditions
 
Atrophic rhinitis
Atrophic rhinitisAtrophic rhinitis
Atrophic rhinitis
 
Angiofibroma
AngiofibromaAngiofibroma
Angiofibroma
 
Allergic and intrinsic rhinitis
Allergic and intrinsic rhinitisAllergic and intrinsic rhinitis
Allergic and intrinsic rhinitis
 
Otosclerosis
OtosclerosisOtosclerosis
Otosclerosis
 
Vestibular schwannoma and glomus tumors
Vestibular schwannoma and  glomus tumorsVestibular schwannoma and  glomus tumors
Vestibular schwannoma and glomus tumors
 
Meniere's disease
Meniere's diseaseMeniere's disease
Meniere's disease
 
Facial nerve palsy
Facial nerve palsyFacial nerve palsy
Facial nerve palsy
 
Complications of csom
Complications of csomComplications of csom
Complications of csom
 
Clinical features and diagnosis of rhinosinusitis
Clinical features and diagnosis of rhinosinusitisClinical features and diagnosis of rhinosinusitis
Clinical features and diagnosis of rhinosinusitis
 
Obstructive sleep apnea syndrome
Obstructive sleep apnea syndromeObstructive sleep apnea syndrome
Obstructive sleep apnea syndrome
 

Recently uploaded

HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
GL Anaacs
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
aljamhori teaching hospital
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
MedicoseAcademics
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
DrSathishMS1
 
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfMANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Jim Jacob Roy
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Savita Shen $i11
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
Sujoy Dasgupta
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
Anurag Sharma
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
LanceCatedral
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Savita Shen $i11
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
MedicoseAcademics
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
Levi Shapiro
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
bkling
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Oleg Kshivets
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 

Recently uploaded (20)

HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
 
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfMANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 

Neoplasms of nose and pns

  • 1. Neoplasms of Nose and PNS Dr. Krishna Koirala 2019-12-30
  • 2. Classification • Benign –Everted papilloma –Osteoma –Chondroma –Ossifying Fibroma –Hemangioma • Intermediate – Inverted papilloma – Hemangiopericytoma – Oncocytoma • Malignant − Squamous cell carcinoma − Basal cell carcinoma − Adenocarcinoma − Sarcomas − Undifferentiated carcinoma − Malignant melanoma − Minor salivary gland tumors
  • 3. Osteoma • Common incidental finding in sinus x-rays • Most common in frontal sinus • Mostly asymptomatic and do not grow • Surgery required for symptomatic osteomas or those that rapidly increase in size • Complete removal of tumor with its base - done by bicoronal osteoplastic flap technique
  • 7. Tumor removal and closure of bone flap
  • 8. Ossifying fibroma (Fibrous dysplasia) • Normal medullary bone replaced by abnormal proliferation of fibrous tissue, resulting in distortion and expansion of bone • C.T. scan : ground - glass appearance with regions of osteolysis and calcification • Treatment : complete surgical excision • Recurrence common
  • 10. Inverted papilloma • Locally aggressive intermediate sino- nasal tumour • Synonyms: Ringertz tumor, Schneiderian papilloma , Cylindrical cell papilloma • Common in males between 50-70 years • Arises from the lateral wall of nose • Presents as unilateral, friable, leaf like fleshy mass arising from middle meatus • Diagnosis : tissue biopsy
  • 11. C.T. scan Nose and P.N.S. Contrast coronal cuts • Intra-nasal and maxillary mass with opacification of maxillary and ethmoid sinuses • Bone destruction of lateral nasal wall
  • 12. H.P.E. : Inward invasion of hyperplastic epithelium into underlying stroma
  • 13. • Treatment: − Medial maxillectomy and en bloc ethmoidectomy by lateral rhinotomy or midfacial degloving approach is the standard • Squamous cell ca present in 10 -15% cases • Radiotherapy is avoided • Marked tendency to recur after surgical removal − 80% after intrananasal removal − 60% after Caldwell –Luc surgery − 30% after medial maxillectomy
  • 16. Bone removal and & tumor exposure
  • 17. Tumour removed and incision closed
  • 20. Epidemiology • O.5% of all body cancers • 15% of all Head and Neck malignancies • Maxillary sinus is the most common • Squamous cell carcinoma : 80-85% • Adenocarcinoma common in ethmoid • Male : female = 2:1 • Common age group : 45-60 years
  • 21. Risk factors • Hardwood dust (adenocarcinoma) • Softwood dust (squamous cell carcinoma) • Nickel refining; chromium workers • Boot, shoe and textile workers • Mustard gas exposure • Human papilloma virus ??
  • 23. Early Clinical features • Mimics maxillary sinusitis − Nasal stuffiness − Blood-stained nasal discharge − Facial paraesthesia or pain − Epiphora
  • 25. Late clinical features • Medial spread − Unilateral nasal obstruction − Unilateral purulent nasal discharge − Epistaxis − Unilateral, friable, nasal mass • Anterior spread − Cheek swelling − Invasion of facial skin
  • 26. • 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
  • 27.
  • 28. • Posterior spread − Pterygoid muscle involvement  trismus • Intracranial spread − Via Ethmoid, cribriform plate or foramen lacerum • Lymphatic spread − Neck node metastases in late stages • Systemic spread − Lungs, bone ,liver
  • 29. Diagnosis • Diagnostic nasal endoscopy • X-ray paranasal sinus : Expansion and destruction of bony wall • C.T. Scan axial & coronal cuts with contrast • Biopsy
  • 30.
  • 31. Classification • Ohngren's Classification – 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
  • 32. • Lederman’s Classification − 2 horizontal lines of Sebileau pass through floors of orbits & maxillary sinus, producing − Suprastructure : Ethmoid, sphenoid & frontal sinuses; olfactory area of nose − Mesostructure : maxillary sinus & respiratory part of nose − Infrastructure: alveolar process
  • 33.
  • 34. T.N.M. 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
  • 35. Treatment options • T1 /T2 : Surgery or Radiotherapy • T3 : Surgery + Radiotherapy • T4 : Surgery + Radiotherapy +Chemotherapy − Europeans: Pre-operative Radiotherapy (5000-6500 c Gy)  surgery after 4-6 weeks − Americans: Surgery  post-operative Radiotherapy after 4-6 weeks
  • 36. Surgical Options • Total maxillectomy (Weber Fergusson incision) − Malignancy limited to maxilla • Radical maxillectomy with orbital exenteretion (Weber Fergusson Diffenbach incision) − Involvement of orbital fat • Anterior Cranio Facial Resection (extended lateral rhinotomy incision) − Involvement of cribriform plate, frontal sinus
  • 41. Total maxillectomy done and incision closed
  • 42. Palatal defect and prosthesis
  • 43. Indications of orbital exenteretion • 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
  • 46. Cranio-facial resection • Lateral rhinotomy incision combined with midline forehead incision