Benign and Malignant Tumors of Maxillary Sinus - Ashish

8/3/2019 Benign and Malignant Tumors of Maxillary Sinus - Ashish

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Benign tumor-• Antral polyp• Antral papilloma• Osteoma• Ameloblastoma

Malignant tumor-

• Squamous cell carcinoma• Invasion of maxillary sinus by local

malignant disease



BENIGN TUMOR-

Antral polyp:

• The thickened mucosa of chronicallyinflamed sinus frequently forms intoirregular folds called as polyps

• Polypoid atrophy of mucosa maydevelop into an isolated area ornumbers of area throughout the sinus



C l in i c a l f e a t u r e s

• They may arise from any part of thesinus wall and occasionally passthrough the ostium to appear in the

nose as antrochoanal polyps• It usually occurs in young persons

• It may cause bony displacement or

destruction usually on the medial orlateral wall of the sinus



Radiological features :

• Bony destruction may mimic benign andmalignant tumors



Antral papil loma

• It is a rare tumor of respiratory epithelium thatoccurs in the nasal cavityand the paranasal sinus.

Clinical features:

• Sex: It is predominant inmales.

• Site: usually ethmoid andmaxillary sinuses areinvolved.



Symptoms:

• Unilateral nasal obstruction , nasaldischarge pain and epistaxis can occur.

• Recurring sinusitis and subsequentnasal obstruction on the same side.



Radiographic features:

Site : It appears as isolated polyps inthe nose and sinus.

Radiodensity : The neoplasm appearsas homogenous radioopaque mass of soft tissue density.

Pressure effect : bone destruction canoccur due to pressure erosion.



Osteoma :

• It is the most common mesenchymalneoplasm in the paranasal sinus

Clinical features :

• Age and sex : It is more common in the2nd ,3rd and 4th decade.It is more

common in males as compared tofemales and in the ratio of 2:1



Symptom :• It is slow growing and asymptomatic.when

symptom occurs,they are as a result of

obstruction of the sinus ostium orinfundibulum or are secondary to erosion ordeformity,orbital involvement or intracranialextension

• It may extend in the nose and cause nasal



Obstruction or swelling on the side of thecheek

• It may extend into the sinus andproduce swelling of the cheek or hardpalate.

• In cases of extension to orbit, thepatient may have proptosis.



Radiographical features :

Site : they occur more often in frontaland ethmoidal sinus. The maxillary

sinuses are also involved.Shape : Lobulated or rounded

homogenous masses of high densityare seen.

Margins : they have sharply definedmargins.



Ameloblastoma :

• It is most commonextrinsic tumoraffecting the maxillary

sinus.• May cause loosening

of teeth , nasalobstruction and

painless facialdeformity.



• Sinus cavity is invaded at any earlystage . There is radiographic

appearance equivalent to soft tissuedensity.

• Antral cavity is expanded and filled with

soft tissue mass . Bony wall is eroded.



MALIGNANT TUMOR

Squamous cell carcinoma

• It originates from metaplastic epithelium of

the sinus mucous membrane lining

Etiology :

• Sinusitis : Respiratory epithelium is known toundergo squamous metaplasia in thepresence of infection and chronic sinusitis canbe predisposing factor for antral carcinoma



• Snuff and smoke : The use of indigenous snuff and the smokyatmosphere may be causal factor forcarcinoma of paranasal sinus.

• Occupational hazards :It is morecommon in boot and shoe , nickelworker . Adenocarcinoma of the nasal

passage is an occupational hazard forfurniture workers.



Clinical features :

Age and sex : mean age of occurrence is60 years . Males are commonly affected

more than females in ratio of 2:1.Incidence : most common primary tumor of paranasal sinuses comprising 80-90% of cancers in this site.

Symptoms : there is facial pain , swelling ,nasal obstruction and lymphadenopathy.



Medial wall involvement : medial wall

involvement leads to nasal obstruction ,discharge , bleeding and pain ,Epiphoma wall result if the lacrimal sacor nasolacrimal duct is obstructed.

Floor involvement: Involvement of thefloor of the sinus leads to the expansionof the alveolus , unexplained pains ,

numbness of teeth , loose teeth andswelling of the palate.



It may erode the floor and penetrate the

oral cavityLateral wall involvement : lateral wall

involvement leads to facial andvestibular swelling , pain andhyperesthesia of maxillary teeth.

Roof involvement : Roof involvementleads to diplopia , proptosis and pain

over the cheek and upper teeth.



Posterior wall involvement : It leads to

painful trismus , obstruction of eustachian tube , referred pain andhyperesthesia over the distribution of second and third division of trigeminal

nerve.Nerve involvement :It may involved

infraorbital nerve and produces

paresthesia of the cheek or erodesblood vessel giving rise to epistaxis



Radiographic features

(small early lesion)• Shape and radiodensity :non specific well

defined round soft tissue opacity within the

antrum.• Antral wall : variable destruction of thebony antral wall . Loss of fine linear outlineof the lateral wall is a particularly sensitive

sign of bone destruction.(Large well established lesion)

• Pressure effect :destructive outline of the



Sinus destroying bone and causing irregular

bony radiolucency with erosion of medialwall . There may be destruction of the floorand anterior or posterior walls.

• Teeth : occasional resorption and

displacement of the teeth . There may bebone destruction around the teeth or irregularwidening of the periodontal ligament space.

• Zygomatic arch :advanced cases involve



destruction of zygomatic arch.

• Tomography :on the tomography ,there is destruction of the surroundinghard and soft tissue.

Management :

• Cytotocic drugs : local intra-arterial

infusion of cytotoxic drugs may behelpful for pain control.



• Radiotherapy :It is the main mode of treatment. A course of high voltage

radiotherapy or gama rays are given• Surgery : if radiotherapy cannot control

the disease upon the

expectation,excision of the maxillashould be performed

• Reconstruction :after surgery

sophisticated prosthesis should be



Invasion of the maxillary sinusby local malignant disease :

• Tumors of the upper jaw spread easilyinto the sinus.

• Pleomorphic adenoma arising in palatalminor salivary gland may bulge into thesinus floor and adenoid cystic

carcinoma may invade it.



Metastatic carcinoma of themaxillary sinus :

• It is the rare site for the secondary

tumor deposits• The most common site for primary

disease is kidney followed by the breast

in females and the testicles in males



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Benign and Malignant Tumors of Maxillary Sinus - Ashish