nasal and oral cavity

Nasal cavity tumors are more common in men or women

Men

What is the age distribution for nasal cavity tumors?

By model age distribution age 10 to 20 and 50 to 60

Most patient diagnosed with nasal cavity tumors are older than

40

The most common site for a nasal cavity and sinus tumor is

The maxillary sinus

What are some etiologic factors Of nasal and sinus cavity tumors

Smoking, alcohol, chemical and occupational exposures

Adenocarcinoma of the Sino nasal cavity and ethmoid sinus has been associated with what exposure

Wood dust exposure

Squamous is cell carcinoma of the maxillary sinus is associated with what

Chemical agents found in work related to nickel refinery and leather tanning also thorotrast

The nasal cavity has what borders

The hard palate inferiorly base of skull superiorly, nasal vestibule anteriorly, and choanae posteriorly

Laterally the nasal cavity is divided by

The nasal septum

The triangular space defined by the aperture of the nostril laterally by the alley immediately by the membrane septum and inferiorly by the adjacent floor of nasal cavity is

Nasal vestibule

What separates the maxillary sinus from the oral cavity?

The alveolar process and the hard palate

Are nasal and paranasal, sinus cavity tumors found early

No, they are typically found in advanced stages because Their symptoms are often overlooked

Four tumors in the nasal cavity and paranasal sinus they often present with

Epistasis, headache, cranial neuropathy, long-standing sinusitis, nasal obstructions, bloody discharge

What is the work up of a nasal and paranasal sinus tumor consist of

h and p Consisting of a by manual palpation of the orbit, oral and nasal cavities, and nasopharynx and direct fibrotic endoscopy

Should also have a neurologic examination and palpation of cervical lymph nodes

What are the imaging studies used for nasal cavity and paranasal sinus tumors?

CT for detecting bone erosion and MRI for detecting spread and possible chest x-ray

What is often invaded from the maxillary and ethmoid sinus cancers?

The orbit

Most advanced cases that involve the nasal cavity in several sinuses also often include the

Nasopharynx

Paranasal, sinus tumors often like to invade

The orbit, pallet, alveolar process, nasopharynx, zygomatic arch

What is the most common type of cancer in the paranasal and nasal cavity?

Squamous cell carcinoma

The paranasal sinus staging is based on

Extent of invasion and bone erosion

The nasal cavity staging is based on

Extent of invasion

What is the spread pattern of nasal cavity and paranasal sinus tumors?

Limp spread is uncommon, but if it’s present, they typically spread to submandibular and preauricular and submental nodes are at small risk

Loves to spread into open spaces and thin bony partitions

What is the treatment options for nasal vestibule?

Radiation therapy and an excision could be done for very small lesions, but could often produce deformity

Treatment options for nasal cavity

Inverted Paloma without carcinoma is treated by surgery

Carcinoma is treated with surgery and postop radiation therapy

What is the common treatment method for Paranasal sinuses

Surgical resection with postop radiation therapy unresectable lesions can get radiation therapy, but outcomes are poor

What is the treatment for ethmoid sinus tumors?

Surgical resection requires a medial mag ectomy and N block ethmoidectomy

For T3-4 lesions postop RT

What is the treatment approach for maxillary sinus tumors?

Most require a Radical maxillectomy Which is the entire removal of the Maxilla and ethmoid

Followed by postop RT

Borderline resectable lesions can get preop RT followed by surgery.

What is the treatment option for sphenoid, sinus Tumors

Radiation

What are the prognostic factors for nasal cavity and paranasal sinus tumors?

Histology, location, treatment, technique, used, age, and performance status, extent of extension

Nasal cavity and paranasal sinus tumors that have extended to the nasal pharynx, posterior wall or roof of sphenoid, sinus or cavernous sinus significantly increases

Surgical morbidity and decreases the likelihood of obtaining negative surgical margins

Is oral cavity cancer, more common in men or women?

In men

Is the incident of oral cavity cancer, high or low?

Hello

What is the common age for oral cavity cancer?

Most are older than 50 with a mean, age of 62

What are some etiologic factors of oral cavity cancers

In females Plummer Vinson syndrome

Tobacco use, alcohol, betel nut use, lip trauma, poor dental hygiene, HPV, prior radiation exposure

The oral cavity consists of

The upper and lower lips, buccal mucosa, Upper and lowered gingiva, retromolar trigon, hard pallet, four of mouth, and anterior 2/3 of mobile tongue

The oral cavity extends from

The skin vermilion junction of the lip to the posterior border of the hard pallet superiorly into the circumvallate papillae inferiorly

What is the small triangular surface posterior to the third mandibular molar overlying the ascending ramus

The retromolar trigon

The upper gingiva is formed by

The alveolar Ridge of the Maxilla which is covered by mucosa and teeth. It continues medially with the hard palette.

The lower gingiva covers

The mandible from the gingivalbuccal sulcus to the mucosa of the floor of mouth

What are some presenting signs of oral cavity cancer?

Poor dental hygiene, non-healing ulcers with little pain, enlarging, mass, pain, bleeding, foul odor, loose teeth

Who often detect oral cavity cancer

Often asymptomatic, so the dentist are general practitioner, detect it

What is the work up of oral cavity cancer?

History and physical containing a complete head and neck exam, nerve exam, mirror, and or fiber optic examination

Biopsy and maybe exam under anesthesia

Panorex to excess bone Invasion

Dental nutrition, speech, and swallow evaluation

What is the imaging studies for oral cavity cancer?

ACT or MRI with contrast and a PET/CT for stages three and four

Most oral cavity cancers are what type

Squamous cell carcinoma

What is a common cancer for the lip?

Basal cell carcinoma

verrucous carcinoma can occur where

In buccal mucosa

What are the two precursor for oral cavity cancer?

Leukoplakia which is a white patch and erythroplasia, which is a red patch

Staging for oral cavity cancer is based on

Size and depth

Which area in the head and neck has the lowest incident of nodal involvement

Oral cavity

What is the spread of the lips?

Local invasion

The upper lip drains to submandibular and sub gastric

The lower lip does the same, except also goes to submental

Is the upper or lower lip more likely to have lymph involvement?

Upper lip

What is the spread from the retromolar trigon and mucosa?

Submandibular and sub digastric

What is the spread of the hard palette?

Rare and most train to submandibular and deep, cervical nodes

Invade, maxillary, sinus and soft pallet

What is the spread of the floor of mouth?

Extends towards gingiva, tongue, mandibular periosteum, and tongue muscles

Drains to submandibular sub, digastric, and submental lymph nodes

What is the spread of the gingiva?

Most arise from lower ginger and drain to submandibular and sub digastric

Can invade bone retromolar, trigon, adjacent, mucosa, and floor of mouth

What is the spread of the tongue?

Occurs on the lateral and ventral surfaces the tip drains to submental in the anterior 2/3 drains to submandibular in deep cervical

Base of tongue goes directly to mid jugular soap can be frequent for mets

What is the area in the oral cavity that is rich in lymphatics?

The tongue

What are the treatment options for oral cavity cancers?

For lesions smaller than 1 cm they can use surgery alone

In adequate surgical margins or neck note, involvement uses surgery and radiation therapy

Surgery and postop radiation therapy is for T3 to T4 tumors

Postop chemo, combined with radiation is indicated for patients with positive margins or extracapsular noodle spread

What are the prognostic factors for oral cavity cancer?

Early detection, lymph node status, positive lymph node cuts, prognosis in half, for a mouth tumors do better, smoking cessation is vital to improve chance of survival

Sinus staging T1-T4

T1- confined to sinus and no bone

T2- erosion and extension to hard palate

T3- erodes bone of posterior maxillary, ethmoid, medial orbital wall

T4- advanced disease

Nasal cavity staging T1-4

T1- 1 subsite w/ or w/out erosion

T2- 2 subsites

T3- medial wall or floor of orbit, sinus, palate

T4- advanced disease

Oral cavity T1-4

T1- <2 and DOI <5

T2- <2 DOI >5 <10

T3 - >2 <4 DOI >10

T4- advanced