Nasal and Paranasal Cancer

Question 1

RF for Nasal/Paranasal CA

Answer 1

• Toxin exposure (nickel, chromium, mustard gas, hydrocarbons, radium)
• Woodworkers
• Chronic infxn
• Prior radiation

Question 2

What is Ohngren’s line and its significance?

Answer 2

Plane from medial canthus to angle of jaw

-Tumors posterior or superior to this line have poor prognosis due to skull base invasion and PNI

Question 3

What are the 2 m/c sites

Answer 3

1. Maxillary sinus

2. Nasal cavity

Question 4

High or low risk for occult neck mets?

Answer 4

Low risk (< 10%)

Question 5

What are the paranasal subsites?

Answer 5

• Paranasal sinuses
• Nasal cavity
• Anterior cranial fossa
• Pterygopalatine fossa
• Infratemporal fossa
• Orbital cavity

Question 6

paranasal sinus CA

Answer 6

• Maxillary sinus is m/c
• Ethmoid sinus is 2nd m/c sinus site
• Typically advanced (90% invade more than 1 wall)
• Sphenoid has high neuro sequelae rate (CN palsies, orbital Sx, HA)
• Frontal sinus is rare

Question 7

What is the pterygopalatine fossa?

Answer 7

• pyramidal-shaped space below apex of the orbit and b/w posterior wall of maxillary sinus and ptyergoid plates
• Contains
• -Foramen rotundum (CN V2)
• -Vidian nerve
• -Sphenopalatine nerve
• -Lesser and greater palatine nerves
• -Sphenopalatine ganglion
• -Maxillary artery

Question 8

What is the infratemporal fossa

Answer 8

Boundaries

• Ant: Maxilla
• Post: glenoid fossa and mandible
• medially: Lateral ptyergoid plates
• Roof: contains foramen ovale (CN V3) and foramen spinosum

Contains ptyergoid muscles

Question 9

M/c malignancy in sinonasal tissue

Answer 9

SCCa

Question 10

Esthesioneuroblastoma

Answer 10

• From olfactory epithelium
• Pink or brown friable nasal mass
• Tx: excision w/ post-op RT
• Khadish vs Dulguerov-Calcaterra staging

Question 11

Dulguerov-Calcaterra staging for Esthesioneuroblastoma

Answer 11

T1: Nasal cavity + sinus except sphenoid and superior ethmoids
T2: + sphenoid and cribriform
T3: + orbit and/or extradural cranial anterior cranial fossa
T4: brain involvement

Question 12

Sinonasal Undifferentiated Carcinoma (SNUC)

Answer 12

• Extensive tissue destruction

- Rapidly progressive

Question 13

How to manage N0 disease

Answer 13

-Elective neck dissection not indicated (can be considered if tumor involves nasopharynx or soft palate)