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:
- 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 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:
- Squamous
- cell carcinoma
- Adenocarcinoma
- Transitional
- cell carcinoma
- Anaplastic
- carcinoma
- Malignant
- melanoma
- Adenoid
- 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 / anesthesia
- Swelling
- over cheek
Involvement
of inferior wall of maxilla present as:
- Palatal
- swelling
- Swelling
- over buccogingival sulcus
- Loosening
- 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.
- X
- ray 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.