maxillary sinus malignancy
Introduction
Introduction to maxillary sinus malignant tumor According to domestic data, statistical analysis of otolaryngeal tumors, maxillary sinus malignant tumors accounted for 40.3% of nasal malignant tumors, accounting for 1.2% of systemic malignant tumors. Lewis et al (1972) analyzed 772 cases of nasal and sinus cancer, about 30% occurred in In the nasal cavity, 70% occurred in the sinus, and the most occurred in the maxillary sinus, accounting for 58%. The disease is more common in people over the age of 50, the incidence ratio of men and women is 2:1. According to domestic and foreign literature reports, malignant tumors of the maxillary sinus are mainly squamous cell carcinoma, accounting for about 80%; followed by undifferentiated carcinoma, adenocarcinoma, mucinous epithelial carcinoma, cylindrical cell carcinoma, lymphatic epithelial carcinoma, papillary carcinoma, malignant melanoma, malignant Plasmacytoma and cartilage or osteosarcoma. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: swelling
Cause
Causes of maxillary sinus malignancies
According to domestic and foreign literature reports, malignant tumors of the maxillary sinus are mainly squamous cell carcinoma, accounting for about 80%; followed by undifferentiated carcinoma, adenocarcinoma, mucinous epithelial carcinoma, cylindrical cell carcinoma, lymphatic epithelial carcinoma, papillary carcinoma, malignant melanoma, malignant Plasmacytoma and cartilage or osteosarcoma.
Prevention
Maxillary sinus malignant tumor prevention
It is mainly aimed at preventing various factors that may cause malignant tumors of the maxillary sinus. It is currently believed that the loss of normal immune surveillance function, the tumorigenic effect of immunosuppressants, the activity of latent viruses and the long-term application of certain physical (such as radiation), chemical (such as anti-epileptic drugs, adrenocortical hormone) substances, Lead to the proliferation of lymphatic network, and eventually malignant tumors. Therefore, pay attention to personal and environmental hygiene, avoid drug abuse, and pay attention to personal protection when working in a harmful environment.
Complication
Maxillary sinus malignant tumor complications Complications swelling
Tumor invading the nasolacrimal duct, tears can occur, involving the anterior wall of the maxillary sinus, there are swelling of the cheeks, deformity and facial pain, the tumor infiltrates to the bottom, patients often have toothache, swelling of the gums, loose teeth and half of the hard palate Round bulge, etc., is easily misdiagnosed as dental disease. After the tooth extraction treatment, the symptoms are aggravated. The tumor can also develop into the posterior wall of the maxillary sinus, invading the pterygopalatine fossa, causing difficulty in opening the mouth. If the tumor destroys the inferior wall or enters In the sputum, there may be eyeball shift and visual impairment. The tumor may pass through the ethmoid sinus in the late stage, and the eyelid may invade the anterior cranial sinus. It may pass through the pterygoid socket, the pterygopalatine fossa, and then destroy the pterygopalatine fossa, or involve the infraorbital fossa, and enter Middle cranial fossa.
Symptom
Symptoms of maxillary sinus malignant tumors Common symptoms Nasal obstruction headache Gingival swelling Ear pain Tear overflow Eye movement Disorders Difficulty hard palate is a semicircular bulge
The maxillary sinus malignant tumor is difficult to be diagnosed in the early stage because of no symptoms and signs. When the symptoms are obvious in the evening, the diagnosis is difficult. In recent years, the high-resolution CT and MRI image examinations have gradually spread and the multi-angle sinus mirror Clinical application has made it possible to detect sinus tumors at an early stage. Where the masses and sights in the middle nasal passages provide intrasacral space-occupying lesions, the living tissue should be taken for pathological examination as soon as possible. In order to correctly understand the biological characteristics of maxillary sinus malignant tumors, In order to locate the diagnosis, select the procedure and estimate the prognosis, several methods and classification of maxillary sinus cancer are introduced.
1.Ohngren method makes a hypothetical slope between the medial malleolus and the mandibular angle, and then makes a hypothetical vertical plane at the pupil. The maxillary sinus is divided into four quadrants. The tumor growing in the anterior quadrant is easy to invade the ethmoid sinus, and the nasal symptoms and The internal iliac cuff is swollen, and the posterior quadrant is easy to destroy the posterior wall, invading the pterygopalatine fossa and the pterygopalatine fossa, and can further destroy the pterygopalatine fossa, or enter the infraorbital fossa and involve the cranial fossa. Patients may have difficulty in opening the mouth. Head bulge, headache and earache and other symptoms, located in the lower part, the earliest can have dental symptoms, such as swollen gums, loose teeth and so on.
2. Sebileau method from the lower edge of the nose to a hypothetical horizontal plane, the maxillary sinus is divided into upper and lower parts, the upper part of the tumor is easy to invade the ethmoid sinus or eyelids, causing nasal and ocular symptoms, can further invade the skull base, occurs in The prognosis of the lower part is better than that of the upper part.
3. The Lederman method is used to make two horizontal lines from the base of the sac and the base of the maxillary sinus. The two sides of the sinus are made up of two vertical lines from the inner wall of the iliac crest. The upper jaw is divided into upper, middle and lower parts. The vertical line is the ethmoid sinus, nasal cavity and upper part. The dividing line of the maxillary sinus, the nasal septum naturally separates the ethmoid sinus and nasal cavity on both sides. The main advantage of this method is that it basically summarizes the anatomy of the entire upper jaw, upper, middle and lower parts as follows:
(1) Upper ethmoid sinus, frontal sinus, sphenoid sinus (not invading the nasopharynx), nasal olfactory area (ie, above the middle turbinate).
(2) The lateral area of the middle area is the maxillary sinus, the respiratory part of the medial sinus, the nasal vestibule and the lateral wall of the nasal cavity (including the inferior turbinate).
(3) The lower maxillary sinus floor, nasal vestibule, tumor simultaneously invaded the maxillary sinus and hard palate, nasal cavity and hard palate, odontogenic tumor.
The TNM staging of maxillary sinus malignancies is as follows:
Phase I T1N0M0;
Phase II T2N0M0;
Stage III T1, 2N1M0; T3N0M0 has lymph node metastasis, or suspected lymph node metastasis.
Stage IV T4N0M0, T4N1M0, T1, 2, 3N2M0, 1, lymph node metastasis, or distant organ metastasis, Sakai et al (1976) for the maxillary sinus cancer as follows:
Phase I T1 ~ 2N0M0.
Phase II T3N0M0.
Phase III T4N0M0; T1 ~ 4N1M0.
Stage IV T1 ~ 4N2 ~ 3M0; T1 ~ 4N0 ~ 2M1.
The location and grading of malignant tumors of the maxillary sinus is a standard developed by doctors after systematic and local dynamic observation of the disease, and can be used to standardize the diagnosis and treatment behavior of doctors.
According to domestic and foreign literature reports, malignant tumors of the maxillary sinus are mainly squamous cell carcinoma, accounting for about 80%; followed by undifferentiated carcinoma, adenocarcinoma, mucinous epithelial carcinoma, cylindrical cell carcinoma, lymphatic epithelial carcinoma, papillary carcinoma, malignant melanoma, malignant Plasmacytoma and cartilage or osteosarcoma.
[clinical manifestations]
Malignant tumors of the maxillary sinus have different cavities and different primary sites, so they can be asymptomatic at an early stage. More than the examination, it is found that when the tumor grows up and affects the surrounding tissue structure and function, symptoms and signs can be generated. Such as the development of the nasal cavity, there is a nasal congestion, flow sticky pus, blood and odor, nasal examination, visible nasal wall lateral movement to the nasal cavity stenosis, sometimes in the middle nasal or nasal cavity, this is a biopsy clear pathological diagnosis Favorable time, tumor invasion of the nasolacrimal duct, tears can occur, involving the anterior wall of the maxillary sinus, there are swelling of the cheeks, deformity and facial pain, the tumor is infiltrated into the bottom, patients often have toothache, swollen gums, loose teeth and Hard palate is a semi-circular bulge, etc., which is easily misdiagnosed as dental disease. The symptoms are aggravated after tooth extraction. The tumor can also develop into the posterior wall of the maxillary sinus, invading the pterygopalatine fossa, causing difficulty in opening the mouth. Wall or into the sputum, eye movement and visual impairment may occur. The tumor may pass through the ethmoid sinus in the late stage, and the eyelid may invade the anterior cranial sinus, and may pass through the pterygopalatine fossa, the pterygopalatine fossa, and then destroy the pterygopalatine fossa. Involved in the infraorbital fossa, into the cranial fossa, where the clinical internal sacral mass appeared, difficult to open the mouth, neck bulge, intractable headache, earache and other symptoms, all suggesting the possibility of skull base or intracranial metastases, maxillary sinus malignant tumor About 1/2 have lymph node metastasis.
Examine
Examination of maxillary sinus malignancies
High-resolution CT and MRI imaging examinations are becoming more common and multi-angle of sinus surgery for clinical application. It has become possible to detect sinus tumors early. Any lesions and sights in the middle nasal passages that provide intrasacral lesions should be taken as soon as possible. Live tissue for pathological examination.
Diagnosis
Diagnosis and diagnosis of malignant tumor of maxillary sinus
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Different from other sinus tumors: Most of the sinus malignant tumors have no symptoms in the early stage. The symptoms are mainly in the advanced stage, and symptoms similar to sinusitis appear. Symptoms will be progressively worsened, nasal congestion, thick sputum and even blood stasis, nosebleeds, intractable headaches, odor secretions, as well as facial numbness, loose teeth, difficulty opening mouth, eye movement, tearing vision changes, etc. Multiple symptoms.
