Chapter 17. Paranasal Sinus Neoplasms

Essentials of Diagnosis

• Symptoms and signs mimic benign sinonasal disease.
• Malignant tumors typically present at advanced stage of disease.
• Immunohistochemical markers are often required for definitive diagnosis of tumors.

General Considerations

Paranasal sinus neoplasms, both benign and malignant, are relatively rare in the head and neck. Malignant neoplasms of the paranasal sinuses account for approximately 3.0% of head and neck cancers and 0.5% of all malignant tumors. In general, these tumors are identified and treated at advanced stages as their symptoms mimic benign inflammatory conditions. The most common malignant neoplasm of the nose and paranasal sinuses is squamous cell carcinoma. This tumor most commonly arises from the maxillary antrum and secondarily from the ethmoid sinus. Treatment includes surgical resection, radiation therapy, and, rarely, chemotherapy. Benign tumors present in a similar manner and typically necessitate surgical resection and close postoperative follow-up. As nasal endoscopes are used with increasing frequency clinically, both benign and malignant tumors will ideally be identified earlier in the disease progression.

Clinical Findings

Symptoms and Signs

The most common presenting symptoms in patients with paranasal sinus neoplasms are nasal obstruction, rhinorrhea, and sinus congestion that are similar to those of patients with benign sinonasal diseases. However, as the masses grow, paranasal sinus neoplasms lead to facial pain and epistaxis. In addition, orbital symptoms, such as diplopia, proptosis, visual loss, and epiphora, can occur with either neoplastic invasion or expansion into the orbit. Entry through the skull base into the anterior cranial fossa can lead to the symptoms of headache, cranial neuropathies, and occasional frontal lobe symptoms (such as personality alterations). Tumors can also invade the maxilla and present as a hard-palate mass.

Physical Examination

The physical examination of a patient suspected to have a paranasal neoplasm should include a complete head and neck examination, which includes diagnostic nasal endoscopy. While small tumors grow silently without symptoms, persistent nasal symptoms should be evaluated with nasal endoscopy.

Nose and Paranasal Sinus

The examination of the nose and paranasal sinus cavity can reveal a nasal mass with overlying polyps or polypoid mucosa. The septum can be markedly deviated to the contralateral side because of the expansion of the neoplasm, sometimes with tumor erosion into the contralateral nasal cavity. An endoscopic evaluation is superior at evaluating the mucosa, identifying masses and drainage.

Oral Cavity

The teeth and hard palate need to be examined closely to determine if invasion into the maxilla has occurred. An expanded alveolar ridge or loose maxillary dentition indicates early bony invasion of the maxilla, and a mass on the hard palate indicates frank invasion into the maxilla.

Face and Orbit

Facial swelling and thickening of the cheek ...