Tumours of the nose, sinuses and nasopharynx
✓
Nasal and sinus tumours are typically squamous cell carcinomas (SCC) and metastasize to the lymph nodes of the neck. They are rare, and
often not diagnosed until they have spread to surrounding structures.
Aetiology
Tobacco and alcohol
are important aetiological factors. Men are more commonly affected. One
of the risk factors for development of adenocarcinoma of the max- illary antrum is exposure
to the resins produced by hardwoods
and woodworkers are at increased risk. Take a careful occupational history. Nasopharyngeal Carci- noma (NPC) is rare in Europe but relatively common in the Far East in general and in southern China in particular. The Epstein–Barr virus plays a role in the aetiology of nasopharyngeal malignancy. Dietary factors – salted fish and meats – may partly explain the increased risk in South
China but genetic
factors are important
as well.
Carcinoma of the maxillary and ethmoidal sinuses
Clinical features
In its earliest stages these tumours cause no symptoms. Blood-stained nasal dis- charge and increasing unilateral nasal obstruction should raise suspicion.
Late features are sadly often the presenting features and include:
•
Unilateral facial swelling.
•
Swelling or ulceration of the gums or palate.
•
Epiphora, owing to involvement of the nasolacrimal duct.
•
Proptosis and
diplopia, due to involvement
of the
floor
of the orbit.
•
Pain – commonly in
the cheek, but may
be referred to the ear, head or
jaw
•
Metastatic neck
nodes
Malignant disease of the nasopharynx
Clinical features
•
Nasal obstruction and blood-stained nasal discharge.
•
Patients may present with
conductive deafness. Otitis
media with effusion
results from Eustachian tube obstruction.
•
Invasion of the skull base causes involvement of various cranial nerves, especially nerves V (paraesthesia in the face and corneal anaesthesia), VI (ophthalmople- gia), IX (pain in the throat, loss of gag reflex), X (hoarseness) and XII (abnormal tongue movement).
•
Enlarged cervical nodes –
may be
bilateral.
Other tumours of the nasal region (Fig. 19.1)
Osteomata
Osteomata are benign bony tumours usually in the frontal and ethmoidal sinuses. They are slow-growing and cause few symptoms but may eventually call for surgical removal.
Nasopharyngeal angiofibroma
Nasopharyngeal angiofibroma is a rare benign
tumour of adolescent boys. It pre- sents as
epistaxis and nasal obstruction, and is usually
easily visible by posterior rhi- noscopy. Being highly vascular, the tumour is locally destructive and extends into the surrounding structures. Diagnosis is confirmed by MR scanning.
Malignant granuloma
Though not truly neoplastic, malignant granuloma is a sinister condition
character- ized by progressive ulceration of the nose and neighbouring structures. This is prob- ably a variant of lymphoma.
Malignant melanoma
Malignant melanoma is fortunately rare in the nose and sinuses.
Treatment is by radical surgery but the prognosis is extremely poor.
Treatment of nasal and sinus tumours
• Treatment of nasopharyngeal cancer is mainly by radiotherapy. Surgery may be needed for late disease and for neck metastases.• Antro-ethmoidal tumours may be too far advanced for curative treatment at presentation. A combination of surgery and radiotherapy offers the bestchance. Total maxillectomy (with exenteration of the orbit if involved) may be needed. This results in a large defect in the hard palate, for which a modified upper denture with an obturator is provided. Even with radical treatment, nasal sinus carcinoma has a poor prognosis, with only about 30% of patients surviving to 5 years.Angiofibroma is treated by surgical removal with a good prognosis
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