neoplasms of nose and pns
TRANSCRIPT
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NEOPLASMS OF NOSE AND PNS
DR MD ROOHIA
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CLASSIFICATIONNasal cavity
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PNSBENIGN NEOPLASMS
MALIGNANT NEOPLASMS
Osteomas Carcinoma of Maxillary Sinus
Fibrous Dysplasias Ethmoidal sinus malignancy
Ossifying Fibroma Frontal sinus malignancy
Ameloblastoma(adamantinoma)
Sphenoid sinus malignancy
Inverted papilloma
Meningioma&haemangioma
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EPIDEMIOLOGY
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RISK FACTORS
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Benign neoplasms of nasal cavity1. Squamous papillomaVerrucous lesions similar to skin
warts. Involves nasal vestibule or lower
part of nasal septum. Single or multiple,
pedunculated or sessile Treatment is
cauterisation ,cryosurgery or laser.
2. Pleomorphic adenomaRare ,arises from the nasal
septum. 3. Schwannoma and
meningiomaUncommon , found intranasally.
Endoscopic view nasal papilloma
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4.Haemangiomaa) Capillary
haemangioma (Bleeding polypus of the septum) . It is a soft, dark red, pedunculated orsessile
Epiastaxis,nasal obstruction
Treatment is local excision(b) Cavernous
haemangioma . It arises from the turbinates
surgical excision
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5. Chondroma from the ethmoid, nasal cavity or nasal
septum. Pure chondromas are smooth, firm and lobulated.
Treatment is surgical excision6. AngiofibromaIt is included in nasal tumours because its
primary site of origin is supposed to be posterior part of nasal
cavity near the sphenopalatine foramen
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7. Intranasal meningoencephalocele
It is herniation of brain tissues and meninges through foramen caecum or cribriform plate.
It presents as a smooth polyp in the upper part of nose between the septum and middle turbinate,
usually in infants and young children. The mass increases in size on crying or straining.
CT scan is essential to demonstrate a defect in the base of skull.
Treatment is frontal craniotomy, severing the stalk from the brain, and repair of dural and bony
defect. Intranasal mass is removed
Meningoencehalocele b/n middle.t & sup.t
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8. GliomasOf all the gliomas, 30% are
intranasal and 10% both intra and extranasal. They are seen in infants and children.
An intranasal glioma presents as a firm polyp.
9. Nasal dermoid It presents as widening of upper
part of nasal septum with splaying of nasal bones and hypertelorism.
A pit or a sinus may be seen in the midline of nasal dorsum with hair protruding from the opening.
Intra nasal glioma
Nasal dermoid cyst
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Malignant neolasms of nasal cavityPrimary carcinoma per se is rare. It may be an extension of
maxillary or ethmoid carcinoma(a) Squamous cell carcinoma . It may arise from the
vestibule, anterior part of nasal septum or the lateral wall of nasal cavity. (i) Vestibular: It arises from the lateral wall of nasal
vestibule and may extend into the columella,nasal floor and upper lip with metastases to parotid nodes.(ii) Septal: Mostly arises from mucocutaneous junction
and causes burning and soreness in thenose. It has often been termed as "nose-picker's cancer.(iii) Lateral wall: Easily extends into ethmoid or maxillary
sinuses. Grossly, it presents as a polypoid mass in the lateral wall of nose.
(b) Adenocarcinoma and adenoid cystic carcinoma . They arise from the glands of mucous membrane or minor salivary glands and mostly involve upper part of the lateral wall of nasal cavity
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SCC of vestibule
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2. Malignant melanoma 50 years of age. Both sexes are equally
affected. presents as a slaty-grey or
bluish-black polypoid mass. Within the nasal cavity,.
most frequent site is anterior part of nasal septum followed by middle and inferior turbinate.
Tumour spreads by lymphatics and blood stream.
Treatment is wide surgical excision.
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3. Olfactory neuroblastoma (esthesio neuroblastoma) tumour of olfactory placode . either sex at any age group. It presents as a cherry red,
polypoidal mass in the upper third of the nasal cavity
surgical excision followed by radiation
4. Haemangiopericytoma tumour of vascular origin. age group of 60-70 and presents
with epistaxis It arises from the pericyte-a cell
surrounding the capillaries Treatment is wide surgical
excision.
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5. LymphomaRarely a non-Hodgkin lymphoma presents on the
septum.6. Plasmacytomapredominantly affects males over 40 years. Treatment is by radiotherapy followed three months
later bysurgery if total regression does not occur.7. SarcomasOsteogenic sarcoma, chondrosarcoma,
rhabdomyosarcoma angiosarcoma, malignant histiocytoma are other rare tumours affecting the nose.
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Neoplasms of Paranasal SinusesOSTEOMAS:most commonly seen in
the frontal sinusdiscovered incidentally
on X-raysSurgical excision for
raidly growing osteomasComplete removal of
tumour with its base attachment is done by bicoronal osteoplastic flap technique
Frontal sinus osteoma
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Osteoplastic flap technique
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Osteoma exposed
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Tumour removal+closing of bone flap
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Ossifying fibromaSynonym: Fibrous dysplasiaNormally medullary bone is
replaced by abnormal proliferation of fibrous tissue, resulting in distortion & expantion of bone.
CT SCAN: ground glass appearance with regioins of osteolysis & calcification
TREATMENT: complete surgical excision
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INVERTED PAPILLOMALocally aggressive sino-
nasal tumour.Synonym:Rigertz or
Schneiderian papilloma Common in males between
50-70 years It arises from the lateral
wall of nose Presents as unilateral,
friable,pale,pink mass arising from middle meatus
Diagnosis made by punch biopsy
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INVERTED PAPILLOMATreatment: medial
maxillectomy & enbloc ethmoidectomy by lateral rhinotomy or midfacial degloving.
Inverted papilloma has a marked tendency to recur after surgical removal
Sqamous cell ca.present in 10-15% cases
Radiotherapy avoided.Anterior rhinoscopy
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Contrast CT PNS Left intra nasal mass
with opacification of maxillary & ethmoid sinuses (African continent sign)
Bone destruction of lateral nasal wall
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Punch biopsy & HPEInward invasion of hyperplastic epithelium
into underlying stroma No evidence of malignancy.
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Moure’s lateral rhinotomy
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Osteotomy cuts Bone removed & tumour exosed
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Tumour removed & incision closed
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Midfacial degloving approach
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Malignant neoplasms of PNSMAXILLARY SINUS CARCINOMAEarly clinical featuresNasal stuffinessBlood stained nasal dischargeFacial paraesthesias or painepiphora
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Late clinical featuresMedial spread:Unilateral nasal
obstructionUnilateral purulent
nasal dischargeEpistaxis Unilateral ,friable,
nasal mass Anterior spread:cheek swelling Invasion of Facial skin
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Cheek skin involved Nasal mass
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Inferior spread: expansion of alveolus
with dental pain Loosening of teeth ,poor
fitting of dentaturesSwelling in hard palate
or alveolus Superior spread:Proptosis DiplopiaOccular pain Alveola &palatal swelling
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Posterior spread:Pterygoid muscle
involvement- trismusIntracranial spread via:Ethmoids, cribriform
or foramen lacerumLymphatic spread:
neck node metastasis in late stages
Systemic spread: lungs ,bone
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Diagnosis Diagnostic nasal
endoscopy Xray PNS :
expansion & destruction of bony wall
C.t, scan PNS: with contrast
Biopsy
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Ohngren’s classificationOhngren’s line: An imaginary plane
extending b/n medial canthas of eye & angle of mandible
Supra structural growth situated above this plane have poor prognosis
Infra structural growth below this plane have better prognosis
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LEDERMAN’S CLASSIFICATION2 horizantal lines of
sebileau pass through floors of orbits & maxillary sinus, producing:
Supra structure: ethmoid,sphenoid& frontal sinuses:olfactory area of nose.
Mesostructure : maxillary sinus & respiratory part of nose
Infrastructure: Alveolar processes
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TNM STAGING
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TREATMENTT1 & T2: surgery or radiotherapyT 3: surgery + radiotherapyT4 : surgery + radiotherapy+ chemotherapyEuropeans : Preop radiotherapy (5000cGy-
6000cGy) then surgery after 4-6wksAmericans : surgery then postop RT 4-6wks
later.
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Surgical options1.Total maxillectomy Weber fergusson incision In Malignancy limited to maxilla2. radical maxillectomy with orbital
exenterationIn involvement of orbital fat 3.anterior cranio facial ressection Extended lateral rhinotomy incision In involvement of cribriform late, frontal
sinus
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TOTAL MAXILLECTOMYTARSORRHAPHY
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WEBER FERGUSSON INCISION
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OSTEOTOMY CUTS
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TOTAL ,MAXILLETOMY DONE &INCISION CLOSED
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PALATAL DEFECTS & PROSTHESIS
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CRANIO FACIAL RESSECTION
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THANK YOU