Maxillary sinus carcinoma

Cancers involving maxillary sinus are rather uncommon. Incidence ranges between 0.5-1% of all malignancies. It constitutes about 3% of all head and neck malignancies.

Etiological factors include:

Viral infections – EB virus, and Human papilloma virus infections

Exposure to wood dust – Especially African Mahogany wood dust causes adenocarcinoma of maxillary sinus. People working in nickel and chrome industries are more prone to develop cancer of maxillary sinus. People working in leather industries are also known to develop cancer of maxillary sinus

Iatrogenic causes – Post irradiation

Use of snuff have also been documented to be the causative factor

Commonest type of malignancy involving the maxillary sinus is squamous cell carcinoma about 80%. The second commonest tumor involving the maxillar sinus is adenocarcinoma.

The following are the various types of malignant tumors of maxillary sinus:

Squamous cell carcinomaAdenocarcinoma

Transitional cell carcinoma

Anaplastic carcinoma

Malignant melanomaAdenoid

cystic carcinoma

Olfactory neuroblastoma

Lymphomas Clinical features:

Face – Swelling of the cheek. Pain and paresthesia over the cheek.

Orbital – Proptosis, diplopia, loss of vision

Nasal – Nasal deformity, unilateral nasal obstruction, blood tinged nasal

discharge, epistaxis, hyposima (rare)

Neurological – Multiple cranial nerve paralysis

Oral – Loosening of teeth, ill fitting dentures, swelling involving palate, trismus (due to involvement of pterygoid muscles)

Otological symptoms – Ear block due to eustachean tube involvement, referred otalgia

Cervical symptoms – Cervical nodal metastasis

Involvement of anterolateral wall of maxilla present as: Infraorbial nerve paresthesia / anesthesiaSwelling over cheek

Involvement of inferior wall of maxilla present as: Palatal swellingSwelling over buccogingival sulcusLoosening of upper dentition

Oroantral fistula

Trismus is seen in patients with involvement of pterygoid muscles

Involvement of floor of orbit present as:

Restriction

of ocular movement

Proptosis

Periosteal thickening over orbital rim

Involvement of medial wall presents as:

Mass inside nasal cavity

Investigations:

Nasal endoscopy – If there is involvement of medial wall of maxilla the mass could be seen to present itself inside the nasal cavity. If the mass could be seen within the nasal cavity biopsy can be taken from the lesion. Under endoscopic vision inferior meatal antrostomy can be performed and the interior of the maxillary sinus can be examined and biopsy can be taken from the lesion.

Xray paranasal sinuses water's view – shows opacity with expansion of the involved maxillary sinus. Erosion of the floor / anterolateral wall of the orbit can also be seen if present CT scan paranasal sinuses – Shows the extent of lesion, involvement of adjacent areas, evidence of bone erosion if present MRI imaging shows better soft tissue delineation. Extension into pterygopalatine fossa can be clearly seen

Biopsy from the lesion is virtually diagnostic.

Management:

The optimal management modality depends on the extent of tumor and the histological type.

Treatment modalitites available:

Surgery

Radiotherapy

Chemotherapy

Combined management modality

If the tumor is confined to the inferior portion of the maxilla the condition is best managed by partial maxillectomy followed by irradiation.

Tumor involving the whole of the maxilla can be managed by total maxillectomy followed by irradiation.

Involvement of orbit can be managed by combining orbital exenteration along with total maxillectomy.

Tumors of maxilla extending to infratemporal fossa can be managed by extended maxillectomy using Barbosa technique. Maxillectomy is combined with condylectomy and resection of pterygoid plate and muscles attached to it.

Neck dissection can be resorted to if neck nodes are involved.

Irradiation: Is given by using Telecobalt or linear accelerator. Dosage include 6500 rads in divided fractions over 5 weeks. It is usually administered 5 days a week.

Chemotherapy: Cisplatin and 5flurouracil can be administered along with radiotherapy. This is preferred in advanced cases of malignancy involving the maxillary sinus.