Tuesday, May 22, 2012

Paranasal sinus tumors may cause sinus headaches

The sinonasal tract comprises paranasal sinuses and nose. Tumors originating within the paranasal sinuses are uncommon. However, tumors of the tract may cause sinus headaches. The sinonasal tumors are more common in male patients of 50-70 years old. It is difficult to treat them because the sinonasal tract is located close to important organs like brain, carotid artery, skull base and orbit. Secondly, in initial stages, these tumors are asymptomatic.
Neoplasms of the tract could be benign as well as malign. For instance, squamous papilloma is benign, whereas squamous cell carcinoma (SCC) is malignant.

Squamous cell carcinoma, the most common sinonasal cancer, is mainly found in the maxillary and ethmoid sinuses. SCC having its source in the mucosa is the most common tumor of the maxillary sinus. On images, SCC may be identified with adenocarcinoma signs, calcification, hemorrhage or internal necrosis. This malignant tumor rarely occurs in the sphenoid and frontal sinuses. Its symptoms resembles to that of benign tumors. For example, nasal congestion and obstruction, and rhinorrhea. However, in advanced stages, sinus headaches, facial pain, proptosis or diplopia may develop. The lethal tumor is generally diagnosed in the advanced stages only.
However, its extension to the cranial base may be spotted in early stages. The stage of tumor influences the treatment. If tumor is detected in the advanced stage, the therapy consists of more than one method, such as chemotherapy, radiation therapy, radical en bloc resection and surgical salvage. In case of the patients who cannot be operated or do not want to be operated, only irradiation is done. Work is still in progress to decide a standardized treatment for the SCC associated with paranasal sinuses.

SCC, an epithelial tumor, is usually related to chronic sinusitis or it may lead to secondary sinusitis. It is thus necessary to distinguish between existing sinusitis inflammation and malignancy. SCC may involve the orbit. Primary SCC is rare.
Basaloid SCC, a rare condition of the sinuses, is extremely invasive. This aggressive tumor is multifocal. Another variant of SCC is verrucous carcinoma, a low-grade tumor.

The tumor may develop anywhere within the sinonasal tract. SCC can affect the neck nodes and local soft tissues. Unilateral purulent nasal discharge and dull pain may indicate the carcinoma. The SCC within the maxillary sinus may distort or cause swelling of the nearby structures, including eye, nose, gingivobuccal sulcus or cheeks.

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