Tumors of the paranasal sinuses

Tumors of the paranasal sinuses localization and clinical manifestations are divided into tumors of the maxillary sinus, ethmoid cells, frontal and basic sinuses.
Benign tumors fibroids, handsome, osteomas, papillomas, adenoma, angiomas, true of cholesteatoma) paranasal sinuses are less common malignant. Forecast in benign tumors are usually benign. The growth of steam beyond sinus causes disfigurement of the face, sometimes the offset of the eyeball. Germination in the skull cavity is rare.
Among malignant tumors occur more often epithelial - squamous, cylindricity, basal cell cancers, adenocarcinoma. Several less common malignant tumor tissue of origin - osteo-, chondro-, fibreboard, angio - and veretenoobraznaya sarcoma, giant cell tumor. Undifferentiated tumors type retikulosarkoma, limfoepiteliomy, undifferentiated cancer and others in the sinuses are rare.
Tumors of the paranasal sinuses usually occur in the elderly, most men. Usually preceded by chronic inflammatory processes, especially polypous nature.
Symptoms the initial manifestations of tumors depends on their location. The pace of further growth and spread of the tumor, the nature of the applied treatment and prognosis significantly associated with its histological structure and biological characteristics.
Malignant tumors are most often affect the maxillary sinus, on the second place there are ethmoid cells, the third - frontal sinus and at last - the main.
Symptoms in the initial stages of the development of tumors of the paranasal sinuses blindly, often disguised inflammatory process. As the tumor growth and its further distribution there are various symptoms that can be divided into four groups.
The first group includes complaints against unilateral respiratory disorders, lowering of smell to full anosmia, the allocation of abnormal secretions from the nose and spontaneous bleeding. These symptoms first occur when the tumor cells lattice of the maze and the inner wall of the maxillary sinus.
The second group of symptoms seen with tumor invasion into the wall socket or the appearance of it reactive changes that may bias the eyeball, violation of innervation of his muscles or to involve in the process the optic nerve. There is a feeling of heaviness in the eyes, blurred vision and other vision disorders. When tumors of the upper wall of the maxillary sinus, the eyeball is shifted upwards and outwards, with the defeat of the lower wall of frontal sinuses it deviates downwards and outwards; tumors of the front and middle of the ethmoid cells with the involvement of the lacrimal bone and paper plates the eye moves outwards. More significant changes occur in the organ of vision by tumors of the sphenoid sinus and posterior ethmoid cells, when the process involved nerves that pass through the eye hole and superior ophthalmic slit, and develops retro-bulbar neuritis, optic nerve atrophy, paralysis of the eye muscles.
The third group of symptoms is characterized by pain of varying intensity in the face and head in connection with involvement in the process of the branches of the trigeminal nerve, bone facial skeleton or skull, meninges etc., and related inflammatory changes.
To the fourth group of symptoms include deformations of the face. So, with the defeat of the front wall of the maxillary and frontal sinuses, a more or less severe swelling on the forehead or cheek, but by tumors of the front and middle of the cells of the lattice maze change the shape of the outer side of the nose. Tumors of the lower section of the maxillary sinus observed lesions of the alveolar process of the upper jaw, and the hard palate. However, the pain in the relevant teeth, their swinging, bulging and ulceration of the hard palate.
Clinical diagnosis is often established only in the late stages of the disease. Therefore vital rentgenokhirurgicheskogo a test that usually make the diagnosis of tumors of the paranasal sinuses much earlier. To clarify histological forms tumor is made biopsy and cytological examination of the content of the sinuses.
Differential diagnosis should be borne in mind chronic inflammatory processes and especially their hyperplastic and polypous forms, cystic education in the sinuses and their chistovodnoe stretching, less specific infectious granuloma.
In malignant tumors of the prognosis depends on the location of the tumor, its histological types, stages of the process and methods of treatment. The metastases of malignant tumors of the paranasal sinuses there is a relatively late, therefore forecast a greater influence the nature of the primary tumor. Usually, the prognosis is very poor with tumors of the sphenoid sinus and posterior ethmoid cells, tumor spreads to the surrounding sinus and organs. In malignant tumors of the frontal sinus and front cells of the lattice maze forecast considerably worse than at the respective tumors of the maxillary sinus.
Treatment in benign tumors exclusively surgery. The tumor was removed mainly extranasal and create a wide anastomosis between the sinus cavity of the nose. Treatment of patients with malignant tumors depends on the location of the primary tumor and the stage of the process. Tumors of the maxillary sinus, front and medium-sized partly ethmoid cells and frontal sinuses treatment of combined radiation and surgery. Purely surgical treatment is ineffective. Radiation therapy is preoperative remote irradiation area of location of the tumor using gamma rays. Further surgery (operation of Denker, Moore and others) is diathermocoagulation tumor removal of part or all of the affected sinus. In a full range of combined treatment is introduction in the postoperative cavity radium preparations, radium-Mesodoria, radioactive cobalt and other of Sometimes this intracavitary radiotherapy replace or complement beam radiation in the postoperative period.
In malignant tumors of the paranasal sinuses is widely used bilateral tubal external carotids. This operation increases the effectiveness of radiation therapy, prevent major bleeding in radical surgical intervention, provides analgesic effect of incurable patients in the last stages of the disease.
In the later stages of malignant tumors of the paranasal sinuses and tumors of the sphenoid sinus and posterior ethmoid cells, when anatomical-topographical features of location of the tumor or most of it prevalence exclude the possibility of compliance with the rules of ablation, during surgery, radiation therapy becomes the main and often only palliative treatment. In addition to surgery and radiation treatments used chemotherapy.