Maxillary sinus carcinoma

1. MAXILLARY SINUS CARCINOMA

2. ANATOMY ANTRUM OF HIGHMORE

3. IMPORTANCE OF THIS SINUS...?? Largest sinus. Most frequent PNS involved in malignancies. Very difficult to treat: Close anatomical proximity to the vital structures. Complete surgical resection is challenging. Remain asymptomatic for a long time.

4. MALIGNANT NEOPLASMS CA nose & PNS constitute 0.44% of all malignancies in India. Frequency : Max.s > Ethm.s > Frontal.s > Sphenoid.s AETIOLOGY : Nickel & chromium refineries( Sq.cell & Anaplastic CA). Mahogony wood industries(Adeno.CA). Leather tanning industries. Bantu tribe of Africa: use of stuff rich in Ni & Cr.

5. CA MAXILLARY SINUS Arises from lining of Maxillary sinus. Middle aged males(40-60yrs). Remain silent for a long time or showing only symptoms of sinusitis. Destroys bony walls and invades the surrounding structures.

6. CA MAXILLARY SINUS Clinical Features: Nasal stuffiness. Blood-stained nasal discharge. Facial paraesthesia or pain. Epiphora . These are early C/F Often misdiagnosed and treated as Sinusitis.

7. Patterns of tumour spread. Anteriorly : cheek and skin. Posteriorly : pterygomaxillary fossa , pterygoid plates, nasopharynx , sphenoid sinus, base of skull. Medially : nasal cavity, NLD. Superiorly : orbits, ethmoid sinuses. Inferiorly : palate, buccal sulcus . Intracranial : ethmoid and cribriform plates. Lymphatic : submandibular , upper jugular, retropharyngeal nodes. Systemic : lungs occasionally.

8. DIAGNOSIS. Radiograph of the sinuses. Computerised tomography (CT) scan. Biopsy.

9. Axial Plane Coronal Plane

10. CLASSIFICATION Ohngren’s Classification. AJCC (American Joint Committee on Cancer). Lederman’s Classification.

11. Ohngren’s Classification. Suprastructure : poor prognosis Infrastructure: good prognosis

12. AJCC CLASSIFICATION.

13. Lederman’s Classification. Ethmoid , sphenoid, frontal sinuses & olfactory area of nose. Maxillary & respiratory part of nose. Alveolar process

14. TNM Classification and Staging. Tumour (T). T1 - tumour limited to maxillary sinus mucosa with no erosion. T2 - bony erosion, extension into hard palate, nasal meatus , except the posterior wall . T3 - invading posterior wall, subcutaneous tissue, floor/medial wall of orbit, pterygoid fossa , ethmoid sinus. T4a - ant.orbit , skin of cheek, pterygoid plates, cribriform plates, sphenoid, frontal sinus. T4b - orbital apex, dura , brain, middle cranial fossa , nasopharynx , cranial nerves other than maxillary division of Trigeminal (V2).

15. Regional Lymph Node (N). Nx - regional lymph nodes cannot be assessed. No - no regional lymph node metastasis. N1 - metastasis in single ipsilateral lymph nodes, not less than 3cms. N2a - single ipsilateral < 6cms. N2b - multiple ipsilateral < 6cms. N2c - bilateral < 6cms. N3 - lymph node > 6cms.

16. Distant Metastasis (M). Mx - Distant metastasis cannot be assessed. Mo - No distant metastasis. M1 - Distant metastasis.

17. TREATMENT Stage 1 & 2 SCC Surgery or Radiation. Stage 3 & 4 SCC Combined modalities . Inoperable tumours Chemoradiation . intra arterial infusion of 5-Fluorouracil or Cisplatin .

18. WEBER-FERGUSSON’S INCISION

19. PROGNOSIS Survival diminishes with stage of tumour. 5 yr survival 40-50% Advances are being made in multimodal therapy with improved Radiation delivery with a hope to improve results.

20. SUMMARY ANATOMY AND RELATION. INCIDENCE AND ETIOLOGY. CLINICAL FEATURES. SPREAD OF TUMOUR. DIAGNOSIS. CLASSIFICATION. CLINICAL STAGING. TREATMENT AND PROGNOSIS.

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