Neoplasms of the Nose & Para Nasal Sinuses - Angelfire of the Nose & Para Nasal Sinuses Department...
Transcript of Neoplasms of the Nose & Para Nasal Sinuses - Angelfire of the Nose & Para Nasal Sinuses Department...
Neoplasms of the Nose & Para Nasal Sinuses
Department of ENTKSHEMA
NEOPLASMS
• BENIGN– Osteomas– Fibrous Dysplasia– Ossifying Fibroma– Ameloblastoma– Inverted Papilloma
• MALIGNANT– Maxillary Sinus– Ethmoids– Frontal Sinus
Osteomas• Benign neoplasms of bone
• TYPES– Localized Ivory Osteoma(Compact Bone) – FRONTAL Sinus
– Cancellous Osteoma – Maxillary & Ethmoidal sinuses
• C/F:– Asymptomatic– Sinusitis– Mucocele
• Mx– Inv: Radiology- Xray/ CT– Rx: Surgical Excision
FIBROUS DYSPLASIABenign hamartomatous lesion affecting bones
(replaced by Fibrous tissue)
• Maxilla > Ethmoids & Frontal• Age: 1st – 2nd decade
• TYPES:– MONO-OSTOTIC– POLY-OSTOTIC ( usually Unilateral)– DISSEMMINATED
• C/FDisfigurement of FaceNasal ObstructionDisplacement of eyes
• Radiology: Lesion – Diffuse margins with Ground glass appearance
(Fine Orange Peel Texture)
• Rx – Cosmetic restructuring surgery
Fibrous dysplasia – Maxilla (Alveolus)
Fibrous dysplasia – Maxilla (Alveolus)
Fibrous dysplasia – Maxilla (Alveolus)
Fibrous dysplasia – Maxilla (Alveolus)
Fibrous dysplasia – Maxilla
Fibrous dysplasia – Ethmoids
Fibrous dysplasia – Ethmoids
Fibrous dysplasia – Ethmoids
Fibrous dysplasia – Ethmoids
Fibrous dysplasia – Ethmoids
HISTORY
• Named in honor of C.Victor Schneider-1600s,
• Ringertz was the first to identify the tendency of SPs to invert into the underlying connective tissue stroma, which differs from other types of papillomas.
Synonyms• Schneiderian papilloma,
• Schneider papilloma,
• Inverting papilloma, inverted papilloma,
• Ringertz tumour
• Fungiform papilloma,cylindrical papilloma,
• Oncocytic papilloma, epithelial papilloma,
• Transitional cell papilloma.
Schneiderian papillomas• Derived from schneiderian mucosa which is of ectodermal
origin(squamous)
– Fungiform: 50%, nasal septum
– Cylindrical: 3%, lateral wall/sinuses
– Inverted: 47%, lateral wall
Inverted Papilloma • Benign/intermediate
• 0.5% to 4% of sinonasal tumors
• Site of Origin: lateral nasal wall esp from the middle turbinate & middle meatus.
• Men ,6 to 7th decades
Inverted Papilloma• locally destructive.
• Recurrence – 0 to 80 %
• Malignant degeneration -2-13%(Av10%)
CLINICAL FEATURESUnilateral nasal obstruction-common
Epistaxis,
Rhinorrhea,
Anosmia
Facial pressure,
Headaches,
Polyps
CLINICAL FEATURES
Unilateral
Grossly appears as a
bulky
firm
granular polyp
HISTOLOGY
Investigations – CT
Investigations - MRI
Investigations - BIOPSY
Inverted Papilloma resection
• Initially via transnasal resection:– 50-80% recurrence
• Medial Maxillectomy via lateral rhinotomy:– Gold Standard– 10-20%
• Midfacial degloving
• Trans antral \ Caldwell-Luc
Inverted Papilloma resection• Endoscopic resection
• Endoscopic medial maxillectomy:– Key concepts:
• Identify the origin of the papilloma• Bony removal of this region
• Recurrent lesions:– Via medial maxillectomy vs. Endoscopic resection– 22%
Inverted papilloma
• Syn: Ringertz Tumor / Transitional cell papilloma• Neoplastic epithelium grows towards basement
membrane• Middle aged males• May be associated with malignancy ( SCC) in
10%• Lateral nasal wall – Unilateral.• Rx: WIDE excision by Lateral rhinotomy
approach/ medial maxillectomy
Paranasal Malignancies
MALIGNANT NEOPLASMS
• PNS Ca:– 1% of all malignancies– 3% of H& N Tumors– 15% of all neoplasms of URT– Max > Ethm > Frontal > Sphenoid
AETIOLOGY
• Mahogany wood industries ( Adeno Ca)
• Nickel refining (Sq. Cell Ca & Anaplastic)
• Leather Tanning industries
• Bantu tribes of South africa
Clinical Features
• Middle Aged Males
• Nasal Stuffiness
• Blood stained Nasal discharge
• Parasthesia over cheek
• Epiphora
Ca. Rt Maxilla
Investigations
• Xray PNS• CT Scan with contrast – PNS ( Coronal & Axial)• Biopsy – Nasal Mass / Endoscopic
Spread
Classification
• OHNGREN’s Classification• AJCC Classification• Lederman’s Classification
OHNGREN’S LINE
STAGING
• T1- Infrastructure without bone destruction
• T2- Suprastructure without bone destructionor Infrastructure with bone destruction (medial & Infr. walls)
• T3- cheek,orbit,anterior ethmoids or pterygoid M
• T4- cribriform plate, posterior ethmoids, sphenoid, NaPhx,Pterygoid plates or skull base.
•SuprastructureEthmoidal,Sphenoidal, Frontal&Olfactory area
•MesostructureMaxillary sinus
Nasal cavity
•InfrastructureAlveolar Process
Lines of SEBILEAU
N2a pN2a
>3cm
Weber Fergusson Incision
Lynch extensionSupra ciliary extension
Sub ciliary extension
Lateral Rhinotomy
Surgeries
• Total Maxillectomy• Partial Maxilectomy
Radiotherapy
• 200 RADS - 5days a week X 6 weeks
~ 6000RADS
5 Year survival rate = 25-30%.