Sinonasal Tumour Flashcards
Common benign tumours
- epithelial: inverted papilloma
- vascular: juvenile angiofibroma hemangioma
- bone and cartilages: osteoma, fibrous dysplasia
- neuroectodermal/neural: schwannoma, meningioma
Clinical presentation of benign tumours
- nasal obstruction
- epsistaxis
- rhinorrhea
- hyposmia
- headache
Inverted papilloma
- incidence
- describe
- association with which virus
- site of origin
- staging
- tx
- cx
Incidence: male, 5th-6th decades
Describe: frond like projection, gray to pink lesion, exophytic and polypoidal mass
Association with HPV
- 6&11: benign papillary tumours
- 16&18: malignant degeneration
Site of origin
- lat wall of nose
- maxillary sinus
- ethmoid sinus
Krouse staging
Type 1: involved nasal cavity
Type 2: OMC, ethmoid, medial portion of maxillary sinus
Type 3: all maxilary sinus, sphenoid, frontal
Type 4: intraorbital, intracranial
Tx
- open approach: lateral rhinotomy
- endoscopy approach: endoscopic partial medial maxillectomy
- radiotherapy
Juvenile nasopharyngeal angiofibroma
- Which group
- symptoms
- signs
- ix
- tx
- adolescent
- unilateral epistaxis and obstruction
- smooth lobulated mass
- MUST avoid biopsy. Expansile tumour may invade cranial vault or orbit
- treatment via surgery
Hemangioma
- when it occurs
- incidence
- types of vascular malformations
- classification
- common site
- pe
- mx
- present from birth and persist throughout life
- peak in 4th decade of life
- types:
low flow: venous malformation (blue colour and easily compressible)
high flow: arteriovenous malformation - fletcher classification
- common site: keisselbach area, lateral wall of nose, inferior and middle turbinates
- pe: red-blue, soft and spongy mass or nodule
- tx: endoscopic endonasal resection, preop embolization for extensive tumours, radiotherapy for unresectable or inaccessible lesions
Types of Neuroectodermal/neural tumours
- schwannoma
- meningioma
- nasal glioma
Schwannoma
- common site
- tx
- maxillary division of trigeminal nerve, ophthalmic devision of trigeminal nerve
- tx: surgical excision
Sinonasal meningioma
- arise from
- tx
- arise from meningothelial arachnoid cells
- tx: surgical excision
Nasal glioma
- common in which group
- common site
- infants and children
- intranasal and extranasal
Types of malignant tumours
- scc
- adenoca
- sinonasal ca
- lymphoma
- malignant melanoma
Sinonasal ca
- predominant in
- origin site
- RF
- elderly male
- maxillary sinus, nasal cavity, ethmoid sinus
- RF: nickel workers, wood dust leather furniture workers, other inhalants such ad chrome pigment, radium dial implant
Symptoms of maxillary tumours
Nasal findings: nasal obstruction, epistaxis, anosmia, rhinorrhea, postnasal discharge
Oral sx: toothache, ill fitting dentures, trismus, malocclusion
Ocular findings: epiphora, diplopia, proptosis
Facial signs: facial numbness, facial asymmetry
Symptoms of ethmoid sinus tumour
- may invade orbit, maxillary sinus, sphenoid sinus, anterior cranial fossa
- unilat nasal obstruction, severe headache, diplopia, proptosis, broadening of nasal dorsum
Location and symptoms of sphenoid sinus tumours
Location: inferior and anterior to optic chiasma and pituitary gland and between carotid arteries
Symptoms: headache, diplopia, vision loss
Scc
- location
- treatment
Location: maxillary sinus, nasal cavity
Tx: medial, inferior or radical maxillectomy, craniofacial resection, palliative radiotherapy
