Tumors of nose and paranasal sinus dr.sithanandhakumar -13.06.16
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Transcript of Tumors of nose and paranasal sinus dr.sithanandhakumar -13.06.16
TUMORS OF NOSE AND PARANASAL SINUS
CLASSIFICATION
INVERTED PAPILLOMABenign neoplasm
Schneiderian membrane-neuro-ectodermal origin
Conrad Victor Schneider
Accounts for 5% of all benign tumors
Schneiderian papilloma
Ringertz tumor
Transitional cell papilloma
Inverted papillomamicroscopically 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
Inverted papillomaGreyish 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
CLINICAL FEATURESU/L NASAL OBSTRUCTION
BLEEDING FROM THE NOSE
U/L NASAL MASS RESEMBLING A POLYP
KROUSE STAGING
CT SCANBone erosion, thinning,
remodelling, sclerosis.
hyperdense areas with linear calcification
TREATMENTMEDIAL MAXILLECTOMY- Endoscopic/External
Lateral Rhinotomy by MOURE’S incision
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
osteoma Fibrous dysplasiaMc 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
Malignant tumors
EPIDEMIOLOGYIncidence - 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 % )
Malignancy of PNSMaxillary sinus most commonly involved
Followed by ethmoid and frontal sinus
Squamous cell carcinoma –most common histological type
Adenocarcinoma –common in wood workers
Risk factorsInhalation of carcinogens – 40%
Hardwood dust (adenocarcinoma) – 70 times riskSoftwood dust (squamous carcinoma)
Nickel refining (250 times); chromium workers
Boot , shoe & textile workers
Isopropyl oil, volatile hydrocarbons & mustard gas
Thorotrast dye injection
Snuff
Routes of spread
Clinical featuresOral symptoms
Nasal symptoms
Orbital symptoms
Facial symptoms
CNS symtoms
ORAL SYMTOMSDue 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
Nasal symptomsDue to medial spread
Seen 45-75% patients
u/l nasal obstruction
u/l nasal discharge-blood stained
Orbital symptomsDue to superior spread
Seen 25% of patients
Lid swelling,epiphora
Diplopia , proptosis, impaired vision
Facial symptomsSeen 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
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)
INVESTIGATIONSDNE AND BIOPSY
CECT SCAN
Ohngren’s line
Lederman staging
Treatment Surgery-total maxillectomy
Surgery+radiotherapy
Sandwich therapy
Radiotherapy …..Surgery…..Radiotherapy
Weber Ferguson incision
Thank you