Tumors of the Paranasal Sinuses
Terms in this set (15)
Causative factors for sinus cancer
SCCa: Nickel, aflatoxin, chromium, mustard gas, volatile hydrocarbons, organic fibers found in wood, shoe, and textile industries.
Adenocarcinoma: Wood dust, woodworking, furniture making, leather work.
Exam in sinonasal cancer
Middle ear effusion, nasal cavity mass
Loose dentition, palatal asymmetry, trismus, direct erosion into the oral cavity
Deficits in CN 1, 2, 3, 4, V1, V2, 6
Histopathologic markers of ENB, sinonasal neuroendocrine carcinoma (SNEC), and SNUC
SNUC: Undifferentiated small round blue cell tumor without neural differentiation. Positive for cytokeratin, epithelial membrane antigen
SNEC: Maintains neuronal differentiation, however it is a carcinoma with positive cytokeratin. Also has one or more of the neuroendocrine markers (chromogranin, NSE, synaptophysin).
ENB: Not carcinoma and has significantly positive neuronal differentiation. Positive for chromagranin, synaptophysin. Negative for CK and epithelial membrane antigen.
Unilateral bleeding in a teenage male.
Endoscopy shows a clear lesion originating from the SPA area (Do NOT biopsy in clinic)
CT/MRI shows expansion into the pterygopalatine fossa.
Primary blood supply is from the internal maxillary artery.
Tx = embolization and surgical resection.
Kadish staging system
Used for ENB.
A = tumors of the nasal cavity.
B = Extension into the paranasal sinus.
C = Extension beyond the paranasal sinus.
D = Extension into or beyond the dura.
Maxillary sinus T staging
T1 = limited to mucosa without bone involvement.
T2 = Causes erosion including hard palate and extension into the middle meatus. Cannot involve posterior wall or PPF.
T3 = Invades any of the following: Posterior wall of sinus, orbital floor, subcutaneous tissue, PPF, or ethmoid.
T4a = Invades orbit, skin of face, pterygoid plates, IT fossa, cribriform, sphenoid, or frontal sinuses
T4b = Invades orbital apex, dura, brain, nasopharynx, clivus, or any cranial nerves other than V2
Nasal cavity and ethmoid sinus T staging
T1 = restricted to one subsite without bony invasion.
T2 = Invading 2 adjacent subsites or extending to nasoethmoid complex.
T3 = Invades orbital floor, medial wall, maxillary sinus, palate, or cribriform.
T4a = Invades orbit, skin of face, pterygoid plates, IT fossa, cribriform, sphenoid, or frontal sinuses.
T4b = Invades orbital apex, dura, brain, nasopharynx, clivus, or CN other than V2
Angle of mandible to medial canthus. Tumors anterior/inferior have better outcomes.
Combination of approach via facial incision and frontal craniotomies.
Provides excellent access to the anterior cranial fossa, orbits, and sinonasal cavities.
Allows for en-bloc resection of the skull base/sinuses and dura. Allows direct access for reconstruction of the skul base and dural defect with pericranial flap
Skull base reconstruction
Tensor fascia lata, fat, temporalis fascia, bone grafts, titanium mesh (only for frontal cranioplasty).
Pericranial flap is primary option.
Temporoparietal fascia flap
Temporalis muscle flap
Pedicle = SPA. Ideal for all skull base reconstructions and is the primary option if available. Must be free from cancer involvement.
Inferior turbinate flap
Pedicle = Inferior turbinate artery.
Good for small clival defects. Cannot reach anterior cranial fossa or sella.
Middle turbinate flap
Pedicle = middle turbinate artery.
Good for small anterior cranial fossa or transphenoidal defects. Small, thin mucosa, difficult to elevate.
Pedicle = supraorbital and supratrochlear AA.
hearty flap with versatile dimensions. Extends from anterior cranial fossa to sella, but not to posterior skull base.
Ideal secondary option when nasoseptal flap is not available.
Temporoparietal fascia flap
Pedicle = superficial temporal artery.
Good for clival or paraseptal defects.
90 degree pedicle rotation limits reconstruction of anterior cranial fossa
OTHER SETS BY THIS CREATOR
Reconstructive head and neck surgery
Facial plastic surgery
THIS SET IS OFTEN IN FOLDERS WITH...
Vestibular and Balance disorders
Thyroid and Parathyroid glands
Congenital hearing loss
Cysts and Tumors of the Jaw