30. Benign and malignant tumors of the paranasal sinuses, principles of treatment.

What are the benign tumours of the paranasal sinuses

They’re rare

• papillomas/ inverted papillomas

• osteomas

• ossifying fibromas

• gliomas

• haemangiomas

What are inverted papillomas

• locally aggressive tumour

• can transform into SCC

What are the clinical signs of inverted papilloma

Often asymptomatic until they have reached an advanced stage → non-specific symptoms:

• Nasal airway obstruction, epistaxis, bloody rhinorrhea

• Fetid nasal odor, recurrent bouts of sinusitis, headache, facial pain

• Swelling of the buccal soft tissues, swelling at the medial canthus of the eye

• Infraorbital nerve involvement → hypoesthesia or numbness of cheek

• Orbital infiltration → diplopia, proptosis, eye swelling

How do you diagnose inverted papilloma

• history

• inspection, palpation

• endoscopy- polyp like lesion

• biopsy with histological examination

• CT

What is the treatment of inverted papillomas

• surgical removal

describe osteomas

• benign bone tumour

• in sinuses- commonly occurs as isolated mass in ethmoid and frontal sinus

what are the clinical signs of osteomas

• asymptomatic

• until treached an advanced stage → non specific symptoms

How do you diagnose osteomas

• detected incidentally on skull x ray after head trauma

• history, inspection, palpation

• endoscopy

• biopsy with histological examination + CT

What is the treatment of osteomas

• surgical removal if symptomatic

• no need for therapeutic intervention if asymptomatic

Describe malignant tumours of paranasal sinuses

• more common than benign

• mainly in maxillary sinuses

  • then ethmoid cells, frontal sinus, sphenoid sinus

What are the malignant tumours of the paranasal isnuses

• Tumors of epithelial origin:

  • SCC, adenocarcinoma, adenoid cystic carcinoma

• Tumors of mesenchymal origin:

  • osteosarcomas, chondrosarcomas

• Tumors of lymphoid origin:

  • lymphomas

• Metastasis form:

  • kidney, lung, breast, testis, thyroid gland

What are the symptoms of malignant tumours

• often asymptomatic

• advance stage → non specific symptoms

How do you diagnose malignant tumorus of the sinus

• history, inspection, palpation

• endoscopy

• biopsy with histological exam + aspiration cytology of neck metastasis

• imaging

  • CT, MRI of skull, neck US, CXR, bone scintigraphy ± PER scans

• lab

What is thte TNM staging

• only done for carcinomas of maxillary sinus and athmoidal cells

What is the treatment of malignant tumours

• individualised to histology and extent of malignant tumour

• treatment of choice can consist of preoperative chemotherapy, surgery, postoperative radiation

What is the surgical treatment of malignant tumours

• partial maxilla, or frontal bone resection

• total maxillectomy

• radical maxillectomy + orbital exenteration

  • removal of entire globe and its surrounding structures