1. TUMOURS OF NASAL CAVITY & PARANASAL SINUSES
Col Shoaib Ahmed
Consultant ENT Head & Neck Surgeon
MBBS (Honours) FCPS(Pakistan) FRCS(Glasgow)

2. Review of Anatomy
Paranasal sinuses are air filled cavities that communicate with the nasal cavity
There are close anatomical relations with orbit & skull base
Cranial nerves 1st, 2nd, 3rd ,4th , 5th and 6th are in close vicinity

3. Unique Features of Sinonasal Tumours
Relatively rare of head & neck tumours
Present late
Large air filled sinuses with no vital structure in immediate vicinity → remain clinically silent
Highly non specific early symptoms – (rhinorrhea & nasal obstruction) → receive scant attention
Wide variety of pathological lesions
Extension to anatomically critical areas
Generally advanced disease with poor clinical outcome

4. Classification BENIGN Inverted papilloma Non epithelial Fibroma
Chondroma
Hemangioma
Nerve sheath tumour

5. Classification contd. MALIGNANT Squamous cell carcinoma Non epithelial
Adenocarcinoma
Adenoid cystic carcinoma
Mucoepidermoid carcinoma
Olfactory neuroblastoma / Esthesioneuroblastoma
Non epithelial
Sarcomas
Lymphoma
Giant cell tumour

6. Environmental Factors associated with sinonasal malignancy
Wood dust
Nickel
Hydrocarbons
Chromium
Organic oils
Isopropyl oil

7. Clinical Features EARLY Nasal obstruction Rhinorrhea LATE Epistaxis
Proptosis
Facial pain / swelling
Cranial nerve dysfunction
Trismus

8. How to identify early on ?
Can be readily mimicked by common respiratory conditions (e.g. Sinusitis ) ↓
Unilaterality of symptoms & signs
Persistent & progressive symptoms
No improvement with antibiotics / anti histamines
Unilateral facial pain / numbness / fullness
Short span of symptoms suggests a malignant tumour

9. Clinical Examination Thorough ENT head & neck examination ↓ Trismus
Orbit
Neurological exam (cranial nerves 1st to 6th)
Cervical lymph nodes

10. Diagnosis Always done after imaging Clinical
Imaging (X rays, CT , MRI , PET )
Biopsy
Always done after imaging
(highly vascular lesion, or intra cranial)
Generally under LA

11. Radiological Imaging Plain X rays have lesser value !
45 degrees Occipitomental projection – “X ray PNS”

12. Plain X- rays - Findings
Unilateral findings
Opaque sinus
Gross bone destruction

13. CT scans Initial investigation of choice Shows bony details
Areas of bone destruction
Extension into adjacent areas

14. Normal CT scan
Frontal sinus
Ethmoid sinuses

15. CT scan Unilateral sinonasal mass
Bony erosion of lateral nasal wall and skull base

16. Inverted papilloma

17. Olfactory neuroblastoma in a 14 year old

18. MRI Better soft tissue detail Useful to detect intracranial extension
Able to distinguish nasal secretions from tumour
Indicates extension into dural venous sinuses

19. Positron Emission Tomography (PET scan)
Routine evaluation for recurrent disease after primary tumour
Mainly used for squamous cell carcinoma
Very expensive modality

20. TREATMENT OPTIONS Palliation Surgery Radiotherapy
Combined surgery & radiotherapy
Chemotherapy
Palliation
Lymphomas

21. Olfactory Neuroblastoma in a young lady

29. CONCLUSION
These are rare tumours with poor survival & are generally advanced at presentation
Comprise of several histologic types with varying biological behaviour
Early diagnosis requires being alert for any persistent unilateral symptoms
Diagnosis is based on CT, MRI and biopsy
For cure, extensive mutilating surgery followed by reconstruction is often required

30. DEPARTMENT OF ENT HEAD & NECK SURGERY COMBINED MILITARY HOSPITAL RAWALPINDI

31. Any Questions ?