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:

1. Viral
2. infections – EB virus, and Human papilloma virus infections
3. Exposure
4. to wood dust – Especially African Mahogany wood dust causes
5. adenocarcinoma of maxillary sinus
6. People
7. working in nickel and chrome industries are more prone to develop
8. cancer of maxillary sinus
9. People
10. working in leather industries are also known to develop cancer of
11. maxillary sinus
12. Iatrogenic
13. causes – Post irradiation
14. Use
15. of snuff have also been documented to
16. be the causative factor

Commonest type of malignancy involving the maxillar 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:

1. Squamous
2. cell carcinoma
3. Adenocarcinoma
4. Transitional
5. cell carcinoma
6. Anaplastic
7. carcinoma
8. Malignant
9. melanoma
10. Adenoid
11. cystic carcinoma
12. Olfactory
13. neuroblastoma
14. 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:

1. Infraorbial
2. nerve paresthesia / anesthesia
3. Swelling
4. over cheek

Involvement

of inferior wall of maxilla present as:

1. Palatal
2. swelling
3. Swelling
4. over buccogingival sulcus
5. Loosening
6. of upper dentition
7. Oroantral
8. fistula
9. Trismus
10. is seen in patients with involvement of pterygoid muscles

Involvement

of floor of orbit present as:

1. Restriction
2. of ocular movement
3. Proptosis
4. Periosteal
5. thickening over orbital rim

Involvement

of medial wall presents as:

Mass

inside nasal cavity

Investigations:

1. Nasal
2. endoscopy – If there is involvement of medial wall of maxilla the
3. mass could be seen to present itself inside the nasal cavity. If
4. the mass could be seen within the nasal cavity biopsy can be taken
5. from the lesion. Under
6. endoscopic vision inferior meatal antrostomy can be performed and
7. the interior of the maxillary sinus can be examined and biopsy can
8. be taken from the lesion.
9. X
10. ray paranasal sinuses water's view – shows opacity with expansion
11. of the involved maxillary sinus. Erosion of the floor /
12. anterolateral wall of the orbit can also be seen if present
13. CT
14. scan paranasal sinuses – Shows the extent of lesion, involvement
15. of adjacent areas, evidence of bone erosion if present
16. MRI
17. imaging shows better soft tissue delineation. Extension into
18. 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:

1. Surgery
2. Radiotherapy
3. Chemotherapy
4. Combined
5. 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.