Paranasal sinuses

Of paranasal sinus tumours, 80% occur in the maxillary sinus with the rest arising from the ethmoid, frontal and sphenoid sinuses. The maxillary sinuses are lined by ciliated columnar epithelium and the majority of the malignant epithelial neoplasms are squamous cell carcinoma. Oral signs and symptoms appear early while nasal obstruction and bloody nasal discharge are late symptoms. Invasion of the orbit is associated with ocular signs, including unilateral proptopsis and diplopia. Anterior extension leads to facial asymmetry and deformity. Extension of tumour posteriorly leads to destruction of the pterygoid plates and invasion of the infratemporal fossa. There may be unilateral deafness and facial palsy. Both axial and coronal CT scans are required to define the extent of the paranasal tumour since extension of tumour to adjacent sinuses and structures are common due to delay in presentation and in diagnosis.

Localized tumour can be successfully treated by subtotal maxillectomy, including the orbital floor, hard palate and lower pterygoid plates. Rehabilitation with dental prosthesis is required. For cancer extending to or arising from the ethmoid sinus, a craniofacial resection is required safely to resect the roof of the ethmoid sinus (i.e. the cribriform plate). For extensive malignant tumours not amenable to curative surgical resection, palliation by combined chemotherapy and external radiotherapy may give useful control of the disease. Regional metastasis is uncommon at presentation and distant metastasis is rare.

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