Carcinoma maxillary sinus ent

Introduction: Arises from the sinus lining. It remains silent for a long time (vague "sinusitis" symptoms) before destroying bony confines and invading surrounding structures.

Clinical Features

1. Early Features

• Nasal stuffiness & Blood-stained discharge.
• Facial paraesthesias or pain.
• Epiphora.
• Often missed or treated as simple sinusitis.

2. Late Features (Spread Patterns)

Direction	Clinical Effect
Medial (Nasal)	Obstruction, discharge, epistaxis. Spread to Ethmoids (Antroethmoidal nature).
Anterior	Cheek swelling, invasion of facial skin.
Inferior (Oral)	Expansion of alveolus, dental pain, loosening of teeth, poor denture fit, gingival ulceration, palatal swelling.
Superior (Orbit)	Proptosis, Diplopia, ocular pain, epiphora.
Posterior	Invasion of Pterygopalatine fossa/muscles → Trismus. Spread to nasopharynx/sphenoid.
Intracranial	Via Ethmoids, Cribriform plate, or Foramen lacerum.

3. Metastasis

• Lymphatic: Late stage. Retropharyngeal nodes (inaccessible) → Submandibular & Upper Jugular nodes.
• Systemic: Rare. Lungs (most common), Bone.

Diagnosis

• X-Ray: Opacity + Expansion/Destruction of bony walls.
• CT Scan: Best non-invasive method. Axial & Coronal planes (Essential for staging).
• Biopsy:
  • From nose/mouth if growth is accessible.
  • Endoscopy: Preferred route (accurate).
  • Caldwell-Luc: Exploration for early cases if endoscopy fails.

Classification Systems

1. Ohngren’s Classification

Plane: Medial Canthus ↔ Angle of Mandible.

• Suprastructural (Above): Poorer prognosis.
• Intrastructural (Below): Better prognosis.

2. Lederman’s Classification

Uses 2 horizontal lines of Sebileau (Floor of Orbit & Floor of Antrum).

• Suprastructure: Ethmoid, Sphenoid, Frontal, Olfactory area.
• Mesostructure: Maxillary sinus, Respiratory nose.
• Infrastructure: Alveolar process.

3. AJCC Classification (2002)

Strictly for Squamous Cell Carcinoma.

Tumour Staging (T)
T1	Limited to mucosa. NO bone erosion.
T2	Bone erosion (Hard palate/Middle meatus) excluding posterior wall.
T3	Invades posterior wall, orbit floor/medial wall, pterygoid fossa, ethmoids.
T4a	Invades anterior orbit, skin, cribriform plate, frontal/sphenoid sinus.
T4b	Invades Brain, Dura, Orbital Apex, Clivus, CN other than V2.

Regional Lymph Nodes (N)
N0	No metastasis.
N1	Single ipsilateral node, ≤ 3 cm.
N2a	Single ipsilateral, > 3 cm but ≤ 6 cm.
N2b	Multiple ipsilateral, none > 6 cm.
N2c	Bilateral/Contralateral, none > 6 cm.
N3	Any node > 6 cm.

Distant Metastasis (M): M0 (None), M1 (Present).

Stage Grouping

Treatment

Decision Factor: Histology, Location, and Extent.

1. Early Cases (Stage I & II)

• Surgery OR Radiation.
• Both give equal results.

2. Advanced Cases (Stage III & IV / T3 & T4)

• Combined Modality: Surgery + Radiation.
• Pre-op Radiation: 5500 cGy.
• Post-op Radiation: 5000–5500 cGy.
• New Techniques: 3D-CRT & IMRT (Spare Optic nerve/Lens; cover larger volume).

3. Inoperable / Large Tumours

• Chemoradiation: Concomitant Chemo + RT. (5-yr survival > 60%).
• Intra-arterial Infusion: 5-FU or Cisplatin + RT. (Avoids deformity of extensive surgery).

Prognosis

• Overall 5-year survival: 40–50%.
• Survival diminishes with stage.