上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 tumor of nasal cavity and paranasal sinuses

TumorofNasalcavityandParanasalsinusesDepartmentofOtolaryngology,AffiliatedNinthPeople’sHospitalofShanghaiJiaotongUniversity,SchoolofMedicine

WangPeihua

BenignTumorofNasalcavityandParanasalsinusesPapilloma

（p107)etiologyunknownhumanpapillomavirus,HPVPathology:Hardtype

1small,hard,gray,local,single,mulberry-shaped

2usuallylocatedinnasalvestibule,anteriornasalseptum,hardpalate

3squamousepitheliumSofttypecomparativelylarge,soft,red,diffusegrowth,withpedicle/widebase.SchneiderianmembraneInvertingpapilloma①recurrenttendency②malignantchange③multiplegrowthandhistoclasiaClinicalmanifestation>40y,male>femaleUnilateralPersistent,progressivenasalobstructionmucopurulentdischarge,sometimeswithbloodHeadacheanddysosmiaRhinosinusitisandnasalpolypsExaminationwithdifferentsizeandhardness,Polypoid,red-gray,scobinate,easy-bleeding,usuallylocatedinnasalwall.Treatment

radicalresectionlateralrhinotomy/sublabrumapproach,Maxillectomy+ethmoidotomy(ifnecessary)

EndoscopicSinusSurgery.

MalignantTumorofNasalcavityandParanasalsinuses（p109）Statistics:ENT:20%intotalMalignantTumor.NasalandsinonasalMT:21.74%--49.22%inENTMT.Male:female=3∶1，predilectionage:40～60y.Features:predilectionsiteismaxillarysinus(60～80%),1/3withethmoidsinusMT.

ethmoidsinus>frontalsinus>sphenoidsinus.primarytumor>>metastatictumor.advancedstage>primarystageinvasionofadjacenttissue(orbit,skullbase)Etiologicalfactor

ImmunocompromiceStimulationofchronicinflammationCancerationofbenigntumorExposuretooncogensPathologySCC(35%-66%)，other:adenocarcinoma(onlyinparanasalsinuses),lymphoepithelialcarcinoma,transitionalepithelioma,BCC,sarcoma.Carcinoma>Sarcoma(3.5-9.6:1).

Mostofsarcomaismalignantlymphoma(>60%).clinicalmanifestation1．Nasalobstruction2．EpistaxisorhemicsecretionCarcinomaofmaxillarysinusanterointernal

：odonticsymptomsinearlystage,prognosis↑anteroexternal：posterointernal：→orbit/skullbase,prognosis↓↓posteroexternal：→orbit/parszygomatica,prognosis↓Carcinomaofmaxillarysinus

Clinicalmanifestation:1.Unilateralnasaldischargewithpusandblood2.Unilateralacheandnumbnessofbuccalregion3.Unilateralprogressivenasalobstruction4.UnilateralOdontalgiaandodontcseisisofsuperiorteethCarcinomaofmaxillarysinus1.Oncoidesofbuccalregion2.Eyesymptom3.Oncoidesofhardpalate4.Difficultinopeningmouth5.Basicranialinvasion6.CervicallymphnodemetastasisClinicalmanifestationofadvancedstage:

Carcinomaofethmoidsinusmedialorbitalwall→

proptosis,displacementofglobe→diplopia,hypopsia,swelling/diabrosisofendocanthion/nasalrootUsuallycausedbyCarcinomaofmaxillarysinus,minorityisprimary(epithelioma/sarcoma).

localsorepain,epistaxis,oncoidesofforeheadandsuperior/innerorbitalmargin,displacementofglobeCarcinomaoffrontalsinusCarcinomaofsphenoidsinusPrimarysecondary1.Casehistoryandsigns:40y,unilateral2.Anterior-posteriornasalcavityexamination:neoplasm,diabrosis,necrotictissue,bleeding.Posteriorrhinoscopy3.NasalendoscopyDiagnosis4.Imagingdetection:X-ray,CTscan,MRI

andsoon.5.Biopsy6.TNMclassification（UICC,1997)Treatmentkeypoint-firsttimetreatment

①chemotherapy/radiotherapy+surgery②surgery+chemotherapy/radiotherapyCombinedmodalitytherapy(basedonsurgery)modusoperandi:1.lateralrhinotomy(Moureincision)2.totalmaxillectomy(Weber-Fergussonincision)3.“T”incisioninnasalroot(Presingerincision)4.externalfrontalsinusotomy(Lynchincision)5.sublabialapproach(Denkerincision)6.midfacial

binedcraniofacialapproach

Radiotherapy:Simpleradicalradiati