Tumor of Nasal cavity and Paranasal sinuses Tumor of Nasal cavity and Paranasal sinuses Department of Otolaryngology, Affiliated Ninth People ’ s Hospital of Shanghai Jiaotong University, School of Medicine Wang Peihua

Benign Tumor of Nasal cavity and Paranasal sinuses Benign Tumor of Nasal cavity and Paranasal sinuses

Papilloma （ p107) etiology unknown etiology unknown human papilloma virus, HPV human papilloma virus, HPV

Pathology: Hard type Hard type 1 small, hard, gray, local, single, mulberry- shaped 1 small, hard, gray, local, single, mulberry- shaped 2 usually located in nasal vestibule, anterior nasal septum, hard palate 2 usually located in nasal vestibule, anterior nasal septum, hard palate 3 squamous epithelium 3 squamous epithelium

Soft type Soft type 1 comparatively large, soft, red, diffuse growth, with pedicle/wide base. 2 Schneiderian membrane 3 Inverting papilloma ① recurrent tendency ② malignant change ③ multiple growth and histoclasia

Clinical manifestation  >40y, male>female  Unilateral  Persistent, progressive nasal obstruction  mucopurulent discharge, sometimes with blood  Headache and dysosmia  Rhinosinusitis and nasal polyps

Examination with different size and hardness, Polypoid, red- gray, scobinate, easy-bleeding, usually located in nasal wall. with different size and hardness, Polypoid, red- gray, scobinate, easy-bleeding, usually located in nasal wall.

Treatment radical resection radical resection lateral rhinotomy/ sublabrum approach, Maxillectomy+ ethmoidotomy( if necessary) lateral rhinotomy/ sublabrum approach, Maxillectomy+ ethmoidotomy( if necessary) Endoscopic Sinus Surgery. Endoscopic Sinus Surgery.

Malignant Tumor of Nasal cavity and Paranasal sinuses （ p109 ）

: Statistics: ENT: 20% in total Malignant Tumor. ENT: 20% in total Malignant Tumor. Nasal and sinonasal MT: 21.74% % in ENT MT. Nasal and sinonasal MT: 21.74% % in ENT MT. Male: female =3 ∶ 1 ， predilection age: 40 ～ 60y. Male: female =3 ∶ 1 ， predilection age: 40 ～ 60y.

Features: 1. predilection site is maxillary sinus(60 ～ 80%), 1/3 with ethmoid sinus MT. 2. ethmoid sinus>frontal sinus>sphenoid sinus. 3. primary tumor>>metastatic tumor. 4. advanced stage> primary stage 5. invasion of adjacent tissue( orbit, skull base)

Etiological factor Immunocompromice Immunocompromice Stimulation of chronic inflammation Stimulation of chronic inflammation Canceration of benign tumor Canceration of benign tumor Exposure to oncogens Exposure to oncogens

Pathology 1. SCC(35%-66%) ， other: adenocarcinoma( only in paranasal sinuses), lymphoepithelial carcinoma, transitional epithelioma, BCC, sarcoma. 2. Carcinoma> Sarcoma( : 1). 3. Most of sarcoma is malignant lymphoma(>60%).

clinical manifestation 1 ． Nasal obstruction 2 ． Epistaxis or hemic secretion

Carcinoma of maxillary sinus anterointernal ： odontic symptoms in early stage, prognosis↑ anterointernal ： odontic symptoms in early stage, prognosis↑ anteroexternal ： anteroexternal ： posterointernal ： → orbit/ skull base, prognosis↓↓ posterointernal ： → orbit/ skull base, prognosis↓↓ posteroexternal ： → orbit/ pars zygomatica, prognosis↓ posteroexternal ： → orbit/ pars zygomatica, prognosis↓

Carcinoma of maxillary sinus Clinical manifestation: Clinical manifestation: 1. Unilateral nasal discharge with pus and blood 2. Unilateral ache and numbness of buccal region 3. Unilateral progressive nasal obstruction 4. Unilateral Odontalgia and odontcseisis of superior teeth

Carcinoma of maxillary sinus 1. Oncoides of buccal region 2. Eye symptom 3. Oncoides of hard palate 4. Difficult in opening mouth 5. Basicranial invasion 6. Cervical lymphnode metastasis Clinical manifestation of advanced stage:

Carcinoma of ethmoid sinus medial orbital wall → proptosis, displacement of globe→diplopia, hypopsia, swelling/ diabrosis of endocanthion/nasal root medial orbital wall → proptosis, displacement of globe→diplopia, hypopsia, swelling/ diabrosis of endocanthion/nasal root Usually caused by Carcinoma of maxillary sinus, minority is primary(epithelioma/ sarcoma). Usually caused by Carcinoma of maxillary sinus, minority is primary(epithelioma/ sarcoma).

local sore pain, epistaxis, oncoides of forehead and superior/inner orbital margin, displacement of globe local sore pain, epistaxis, oncoides of forehead and superior/inner orbital margin, displacement of globe Carcinoma of frontal sinus

Carcinoma of sphenoid sinus Primarysecondary

1. Case history and signs:40y, unilateral 2. Anterior-posterior nasal cavity examination: neoplasm, diabrosis, necrotic tissue, bleeding. Posterior rhinoscopy Posterior rhinoscopy 3. Nasal endoscopy Diagnosis

4. Imaging detection: X-ray, CT scan, MRI and so on. 4. Imaging detection: X-ray, CT scan, MRI and so on. 5. Biopsy 5. Biopsy 6. TNM classification （ UICC,1997) 6. TNM classification （ UICC,1997)

Treatment key point- first time treatment ① chemotherapy/ radiotherapy+ surgery ① chemotherapy/ radiotherapy+ surgery ② surgery+ chemotherapy/ radiotherapy ② surgery+ chemotherapy/ radiotherapy Combined modality therapy( based on surgery)

modus operandi : modus operandi : 1. lateral rhinotomy( Moure incision) 2. total maxillectomy( Weber-Fergusson incision) 3. “T” incision in nasal root( Presinger incision) 4. external frontal sinusotomy (Lynch incision) 5. sublabial approach ( Denker incision) 6. midfacial degloving 7. combined craniofacial approach

 Radiotherapy: 1. Simple radical radiation therapy— sarcoma, undifferentiated carcinoma 2. palliative radiation therapy—advanced stage 3. Preoperative radical radiation therapy-- 60Cobalt, linear accelerator, 4-6 weeks, 50-60Gy.  Chemotherapy: