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Nose and PNS Carcinoma (for UNDERGRADUATES)
- 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
- 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)
- 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.
- 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
- 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