MALIGNANT TUMORS OF

THE PARANASAL SINUSES

ENDANG SYAMSUDIN
SUPERVISOR:
DR.HARMAS YAZID YUSUF drg. SpBM

DEPARTMENT OF ORAL SURGERY

FACULTY OF DENTISTRY / HASAN SADIKIN HOSPITAL
PADJADJARAN UNIVERSITY BANDUNG
2003
 INTRODUCTION

MALIGNANT TUMORS OF
THE PARANASAL SINUSES -RELATIVELY RARE, 0,2%
-INITIAL SIMPTOMS SIMILAR
WITH SINUSITIS
-DENTAL SIMPTOMS
-MALE > FEMALE 2:1
-> 40
-SQUAMOUS CELL CARCINOMA 70%
-MAXILLARY SINUS (68-80%),
EXTEND TO ETHMOID, FRONTAL, SPHENOID
ORAL CAVITY &
FACE
ANATOMY OF PARANASAL SINUSES
ANATOMY OF PARANASAL SINUSES
ETIOLOGY
Ú CONTRAST MEDIUM
Ú CIGARETTE SMOKING
Ú FORMALDEHID
Ú NICKEL MINING
Ú CHROMIUM
Ú CHEMICAL MANUFACTURING
Ú LEATHER TANNING
Ú CARPENTRY
 PATHOGENESIS

Ú SQUAMOUS CELL CARCINOMA

-Incidence 70-80% => maxillary & ethmoid sinuses
-frontal & sphenoid are rare,
- > male, sixth decade
- regional lymph node spread from maxillary sinus :
submandibular
-from ethmoid : jugulodigastric & subdigastric
lymph node
 PATHOGENESIS

Ú ADENOCARCINOMA
> Maxillary & ethmoid,
-incidence 5-20%
- clinical signs similar with squamous cell
carcinoma
 PATHOGENESIS

Ú ADENOCYSTIC CARCINOMA
- Incidence 14-17%
- Local recurrences increase
perineural spread along cranial nerves
- Distant metastasis : lung
 PATHOGENESIS

Ú MALIGNANT MELANOMA
- Incidence 3,5 %,
- highest incidence : fifth & eighth decade
- Maxillary sinus : most frequently location
-Typically : polypoid fleshy & pigmentation varies
- Survival rate is very poor
- five year survival : 6 %
 PATHOGENESIS

Ú OSTEOGENIC SARCOMA
-malignant tumor  rare in the sinuses
-Incidence about 5% in the head and neck
-Distant metastasis : 30-40%
-Five year survival rate : 15-20%
 PATHOGENESIS

Ú MALIGNANT LYMPOMA
- > male , fifth – seventh decade
- Non-Hodgkin's type
- 70% : stage IV
- treatment : radiation with or without
chemotherapy
 PATHOGENESIS

Ú OLFACTORY NEUROBLASTOMA
-A slow-growing tumor
-an exophytic polypoid mass
-a smooth surface & aggressive behavior
-Local recurrence : 50-75%
-Metastases : 20-30%
-Most often metastases : regional lymph node,
lung, and bones
 EXTENSION OF TUMOR

Ú ETHMOID SINUS
local extension : orbit medial , nasal cavity,
maxillary sinus, anterior cranial fossa, sphenoid
sinus, nasopharyng

SPHENOID SINUS
Cranial nerves III, IV, VI , cavernous sinus ,
trigeminal nerves branches maxillary &
ophthalmic
EXTENSION OF TUMOR
 SIGNS & SYMPTOMS

Ú NASAL :
- Unilateral obstruction ,unilateral rhinorrhea,
nasal deformity, epistaxis
ORBITA :
diplopia, proptosis, ophthalmoplegia, visual
changes
ORAL:
palate & alveolar ridge fullness / ulcer , dental
pain, trismus
SIGNS & SYMPTOMS
 SIGNS & SYMPTOMS

Ú FACIAL
Cheek swelling, pain, infraorbital nerve
hypesthesia, facial asymmetry
*INTRA CRANIAL
headache, ophtalmoplegia, visual changes,
liquorhea, paresthesia
 DIAGNOSIS
Ú PHYSICAL EXAMINATION
-inspections & palpations
- sinonasal, ocular, & neurologic
systems
*NASO-ENDOSCOPY
*IMAGING STUDIES:
- X-RAY , CT , MRI
*BIOPSY
IMAGING
STUDIES: CT
S
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A
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 TREATMENT
Ú Treatment of cancer depends on location of tumor,
stage of disease, patient’s age and overall health

Surgery, radiation (single, preop /postop),

chemotherapy

Ú Surgery : en bloc surgical resection

unresectability :
extension to frontal lobes (superior extension)
invasion of pravertebral fascia (posterior extension)
bilateral optic nerve involvement,
cavernous sinus extension (lateral extension)
Management of paranasal sinus cancer
 PROGNOSIS
Ú Poorly : late diagnosis, tumor extended,
aggressive & recurrent behavior

CLONCLUSION
*MALIGNANT TUMOR OF PARANASAL SINUS IS RARE
*SIGNS & SYMPTOMS : seen in oral cavity
*DIAGNOSIS : physical examination, nasal endoscopy,
biopsy, imaging studies, CT Scant, MRI
*TREATMENT : Surgery, radiation, chemotherapy
& Multidiscipline approach