Rhinology‎ > ‎

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
    infections – EB virus, and Human papilloma virus infections
  2. Exposure
    to wood dust – Especially African Mahogany wood dust causes
    adenocarcinoma of maxillary sinus
  3. People
    working in nickel and chrome industries are more prone to develop
    cancer of maxillary sinus
  4. People
    working in leather industries are also known to develop cancer of
    maxillary sinus
  5. Iatrogenic
    causes – Post irradiation
  6. 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:

  1. Squamous
    cell carcinoma
  2. Adenocarcinoma
  3. Transitional
    cell carcinoma
  4. Anaplastic
    carcinoma
  5. Malignant
    melanoma
  6. Adenoid
    cystic carcinoma
  7. Olfactory
    neuroblastoma
  8. 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
    nerve paresthesia / anesthesia
  2. Swelling
    over cheek

Involvement
of inferior wall of maxilla present as:

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

Involvement
of floor of orbit present as:

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

Involvement
of medial wall presents as:

Mass
inside nasal cavity

Investigations:

  1. 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.
  2. 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
  3. CT
    scan paranasal sinuses – Shows the extent of lesion, involvement
    of adjacent areas, evidence of bone erosion if present
  4. 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:

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

Comments