Drtbalu: Created page with " Category:Rhinology Cancers involving maxillary sinus are rather uncommon. Incidence ranges between 0.5-1% of all malignancies. It constitutes about 3% of all head and..."

2018-10-16T00:48:08Z

Created page with " Category:Rhinology Cancers involving maxillary sinus are rather uncommon. Incidence ranges between 0.5-1% of all malignancies. It constitutes about 3% of all head and..."

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[[Category:Rhinology]]

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.

Maxillary sinus carcinoma - Revision history

Drtbalu: Created page with " Category:Rhinology Cancers involving maxillary sinus are rather uncommon. Incidence ranges between 0.5-1% of all malignancies. It constitutes about 3% of all head and..."