Maxillary sinus carcinoma

Cancers involving maxillary sinus are rather uncommon. Incidence ranges

between 0.5-1% of all malignancies. It constitutes about 3% of all
head and neck malignancies.
Etiological
factors include:
1. Viral
infections EB virus, and Human papilloma virus infections
2. Exposure
to wood dust Especially African Mahogany wood dust causes
adenocarcinoma of maxillary sinus
3. People
working in nickel and chrome industries are more prone to develop
cancer of maxillary sinus
4. People
working in leather industries are also known to develop cancer of
maxillary sinus
5. Iatrogenic
causes Post irradiation
6. Use
of snuff have also been documented to
be the causative factor
Commonest type of malignancy involving the maxillar sinus is squamous cell
carcinoma about 80%. The second commonest tumor involving the
maxillar sinus is adenocarcinoma.
The following are the various types of malignant tumors of maxillary
sinus:
1. Squamous
cell carcinoma
2. Adenocarcinoma
3. Transitional
cell carcinoma
4. Anaplastic
carcinoma
5. Malignant
melanoma
6. Adenoid
cystic carcinoma
7. Olfactory
neuroblastoma
8. Lymphomas
Clinical features:
Face Swelling of the cheek. Pain and paresthesia over the cheek.
Orbital Proptosis, diplopia, loss of vision
Nasal Nasal deformity, unilateral nasal obstruction, blood tinged nasal
discharge, epistaxis, hyposima (rare)
Neurological Multiple cranial nerve paralysis
Oral Loosening of teeth, ill fitting dentures, swelling involving
palate, trismus (due to involvement of pterygoid muscles)
Otological symptoms Ear block due to eustachean tube involvement, referred
otalgia
Cervical symptoms Cervical nodal metastasis
Involvement of anterolateral wall of maxilla present as:
1. Infraorbial
nerve paresthesia / anesthesia
2. Swelling
over cheek
Involvement
of inferior wall of maxilla present as:
1. Palatal
swelling
2. Swelling
over buccogingival sulcus
3. Loosening
of upper dentition
4. Oroantral
fistula
5. Trismus
is seen in patients with involvement of pterygoid muscles
Involvement
of floor of orbit present as:
1. Restriction
of ocular movement
2. Proptosis
3. Periosteal
thickening over orbital rim
Involvement
of medial wall presents as:
Mass
inside nasal cavity
Investigations:
1. Nasal
endoscopy If there is involvement of medial wall of maxilla the
mass could be seen to present itself inside the nasal cavity. If
the mass could be seen within the nasal cavity biopsy can be taken
from the lesion. Under
endoscopic vision inferior meatal antrostomy can be performed and
the interior of the maxillary sinus can be examined and biopsy can
be taken from the lesion.
2. X
ray paranasal sinuses water's view shows opacity with expansion
of the involved maxillary sinus. Erosion of the floor /
anterolateral wall of the orbit can also be seen if present
3. CT
scan paranasal sinuses Shows the extent of lesion, involvement
of adjacent areas, evidence of bone erosion if present
4. MRI
imaging shows better soft tissue delineation. Extension into
pterygopalatine fossa can be clearly seen
Biopsy
from the lesion is virtually diagnostic.
Management:
The
optimal management modality depends on the extent of tumor and the
histological type.
Treatment
modalitites available:
1. Surgery
2. Radiotherapy
3. Chemotherapy
4. Combined
management modality
If
the tumor is confined to the inferior portion of the maxilla the
condition is best managed by partial maxillectomy followed by
irradiation.
Tumor
involving the whole of the maxilla can be managed by total
maxillectomy followed by irradiation.
Involvement
of orbit can be managed by combining orbital exenteration along with
total maxillectomy.
Tumors
of maxilla extending to infratemporal fossa can be managed by
extended maxillectomy using Barbosa technique. Maxillectomy is
combined with condylectomy and resection of pterygoid plate and
muscles attached to it.
Neck
dissection can be resorted to if neck nodes are involved.
Irradiation:
Is
given by using Telecobalt or linear accelerator. Dosage include 6500
rads in divided fractions over 5 weeks. It is usually administered 5
days a week.
Chemotherapy:
Cisplatin
and 5flurouracil can be administered along with radiotherapy. This
is preferred in advanced cases of malignancy involving the maxillary
sinus.