Benign and Malignant Tumors of Maxillary Sinus - Ashish

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The document discusses various benign and malignant tumors that can occur in the maxillary sinus, including antral polyps, antral papillomas, osteomas, and squamous cell carcinoma. It also describes the clinical features, symptoms, and radiological findings of some of these tumors.

Some of the benign tumors mentioned are antral polyps, antral papillomas, osteomas, and ameloblastomas. The malignant tumors discussed are squamous cell carcinoma and invasion of the maxillary sinus by local malignant disease.

Antral polyps can arise from any part of the sinus wall and occasionally pass through the ostium to appear in the nose. They usually occur in young persons and may cause bony displacement or destruction. Common symptoms include nasal obstruction and discharge.

Benign tumor Antral polyp Antral papilloma Osteoma Ameloblastoma Malignant tumor Squamous cell carcinoma Invasion of maxillary

llary sinus by local malignant disease

BENIGN TUMORAntral polyp:


The thickened mucosa of chronically inflamed sinus frequently forms into irregular folds called as polyps Polypoid atrophy of mucosa may develop into an isolated area or numbers of area throughout the sinus

Clinical features
They may arise from any part of the sinus wall and occasionally pass through the ostium to appear in the nose as antrochoanal polyps It usually occurs in young persons It may cause bony displacement or destruction usually on the medial or lateral wall of the sinus

Radiological features :
Bony destruction may mimic benign and malignant tumors

Antral papilloma
It is a rare tumor of respiratory epithelium that occurs in the nasal cavity and the paranasal sinus. Clinical features: Sex: It is predominant in males. Site: usually ethmoid and maxillary sinuses are involved.

Symptoms: Unilateral nasal obstruction , nasal discharge pain and epistaxis can occur. Recurring sinusitis and subsequent nasal obstruction on the same side.

Radiographic features:
Site : It appears as isolated polyps in the nose and sinus. Radiodensity : The neoplasm appears as homogenous radioopaque mass of soft tissue density. Pressure effect : bone destruction can occur due to pressure erosion.

Osteoma :
It is the most common mesenchymal neoplasm in the paranasal sinus Clinical features : Age and sex : It is more common in the 2nd ,3rd and 4th decade.It is more common in males as compared to females and in the ratio of 2:1

Symptom : It is slow growing and asymptomatic.when symptom occurs,they are as a result of obstruction of the sinus ostium or infundibulum or are secondary to erosion or deformity,orbital involvement or intracranial extension It may extend in the nose and cause nasal

Obstruction or swelling on the side of the cheek It may extend into the sinus and produce swelling of the cheek or hard palate. In cases of extension to orbit, the patient may have proptosis.

Radiographical features :
Site : they occur more often in frontal and ethmoidal sinus. The maxillary sinuses are also involved. Shape : Lobulated or rounded homogenous masses of high density are seen. Margins : they have sharply defined margins.

Ameloblastoma :
It is most common extrinsic tumor affecting the maxillary sinus. May cause loosening of teeth , nasal obstruction and painless facial deformity.

Sinus cavity is invaded at any early stage . There is radiographic appearance equivalent to soft tissue density. Antral cavity is expanded and filled with soft tissue mass . Bony wall is eroded.

MALIGNANT TUMOR Squamous cell carcinoma


It originates from metaplastic epithelium of the sinus mucous membrane lining Etiology : Sinusitis : Respiratory epithelium is known to undergo squamous metaplasia in the presence of infection and chronic sinusitis can be predisposing factor for antral carcinoma

Snuff and smoke : The use of indigenous snuff and the smoky atmosphere may be causal factor for carcinoma of paranasal sinus. Occupational hazards :It is more common in boot and shoe , nickel worker . Adenocarcinoma of the nasal passage is an occupational hazard for furniture workers.

Clinical features :
Age and sex : mean age of occurrence is 60 years . Males are commonly affected more than females in ratio of 2:1. Incidence : most common primary tumor of paranasal sinuses comprising 80-90% of cancers in this site. Symptoms : there is facial pain , swelling , nasal obstruction and lymphadenopathy.

Medial wall involvement : medial wall involvement leads to nasal obstruction , discharge , bleeding and pain , Epiphoma wall result if the lacrimal sac or nasolacrimal duct is obstructed. Floor involvement: Involvement of the floor of the sinus leads to the expansion of the alveolus , unexplained pains , numbness of teeth , loose teeth and swelling of the palate.

It may erode the floor and penetrate the oral cavity Lateral wall involvement : lateral wall involvement leads to facial and vestibular swelling , pain and hyperesthesia of maxillary teeth. Roof involvement : Roof involvement leads to diplopia , proptosis and pain over the cheek and upper teeth.

Posterior wall involvement : It leads to painful trismus , obstruction of eustachian tube , referred pain and hyperesthesia over the distribution of second and third division of trigeminal nerve. Nerve involvement :It may involved infraorbital nerve and produces paresthesia of the cheek or erodes blood vessel giving rise to epistaxis

Radiographic features (small early lesion)


Shape and radiodensity :non specific well defined round soft tissue opacity within the antrum. Antral wall : variable destruction of the bony antral wall . Loss of fine linear outline of the lateral wall is a particularly sensitive sign of bone destruction. (Large well established lesion) Pressure effect :destructive outline of the

Sinus destroying bone and causing irregular bony radiolucency with erosion of medial wall . There may be destruction of the floor and anterior or posterior walls. Teeth : occasional resorption and displacement of the teeth . There may be bone destruction around the teeth or irregular widening of the periodontal ligament space. Zygomatic arch :advanced cases involve

destruction of zygomatic arch. Tomography :on the tomography , there is destruction of the surrounding hard and soft tissue. Management : Cytotocic drugs : local intra-arterial infusion of cytotoxic drugs may be helpful for pain control.

Radiotherapy :It is the main mode of treatment. A course of high voltage radiotherapy or gama rays are given Surgery : if radiotherapy cannot control the disease upon the expectation,excision of the maxilla should be performed Reconstruction :after surgery sophisticated prosthesis should be

Invasion of the maxillary sinus by local malignant disease :


Tumors of the upper jaw spread easily into the sinus. Pleomorphic adenoma arising in palatal minor salivary gland may bulge into the sinus floor and adenoid cystic carcinoma may invade it.

Metastatic carcinoma of the maxillary sinus :


It is the rare site for the secondary tumor deposits The most common site for primary disease is kidney followed by the breast in females and the testicles in males

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