Download Free Medical Tumours of Nose and PNS PowerPoint Presentation

Tumours of Nose and PNS PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : A brief introduction of TUMOURS OF NOSE & PNS, collected from all sources available

Tags : TUMOURS OF NOSE,PNS,NOSE TUMOUR,TUMOUR NOSE

Published on : Aug 22, 2022 | Views : 4212 | Downloads : 22

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Dr Harjitpal Singh Assistant Professor(ENT), Dr RKGMC, Hamirpur TUMORS OF NOSE & PNS
Slide 2-

TUMOURS OF NOSE & PNS Environmental Factors associated with sinonasal malignancy Wood dust (Hardwood-Adeno, Softwood- SCC) Nickel, Hydrocarbons Chromium, Organic oils, Isopropyl oil Mustard Gas Many of these products are found in the furniture-making industry, the leather industry, and the textile industry.
Slide 3-

TUMOURS OF NOSE & PNS Cancers arising in the paranasal sinuses are rare, constituting approximately 3 % of head and neck malignancies Sinonasal malignancies (SNM) are the second most common head and neck cancer behind nasopharyngeal carcinoma. Men are affected 1.5 times more often than women. 80% of these tumors occur in people aged 45-85 years.
Slide 4-

TUMOURS OF NASAL CAVITY Approximately 60-70% of sinonasal malignancies (SNM) occur in the maxillary sinus and 20- 30% occur in the nasal cavity itself. An estimated 10-15% occur in the ethmoid air cells Human papillomavirus (HPV) also has a frequent role in the development of sinonasal SCC
Slide 5-

TUMOURS OF EXTERNAL NOSE
Slide 6-

TUMOURS OF NASAL CAVITY
Slide 7-

BENIGN TUMORS OF NOSE Benign lesions are usually smooth, localised and covered with mucous membrane. In addition to primary tumours, nasal cavity can be invaded by growths from paranasal sinuses, nasopharynx, cranial or buccal cavity.
Slide 8-

BENIGN TUMORS OF NOSE 1. Squamous Papilloma : Verrucous lesions similar to skin warts arise from the nasal vestibule or lower part of nasal septum. Single or multiple, pedunculated or sessile. Treatment : Local excision with cauterisation of the base. Cryosrugery Laser.
Slide 9-

ENDOSCOPIC VIEW NASAL PAPILLOMA
Slide 10-

BENIGN TUMORS OF NOSE 2) Inverted Papilloma (Transitional Cell Papilloma or Ringertz Tumour) Neoplastic epithelium is seen to grow towards underlying stroma rather than on the surface. 40-70 years male preponderance (5:1). Arises from the lateral wall of nose Always unilateral, red or grey masses Translucent and oedematous marked tendency to recur after surgical removal. Associated with squamous cell carcinoma in 10- 15% of patients.
Slide 11-

BENIGN TUMORS OF NOSE Inverted Papilloma Modified Krause Staging A – Inverted papilloma (IP) confined to the nasal cavity, ethmoid sinus, or medial maxillary wall B – Inverted papilloma (IP) with involvement of any maxillary wall (other than the medial wall) or frontal sinus or sphenoid sinus C – Inverted papilloma (IP) with extension beyond the paranasal sinuses Treatment : Wide surgical excision by Medial maxillectomy and enbloc ethmoidectomy or Lateral rhinotomy.
Slide 12-

BENIGN TUMORS OF NOSE 3) Schwannoma and Meningioma : Treatment : Surgical excision by lateral rhinotomy. 4) Pleomorphic Adenoma : Arises from the nasal septum. Treatment : Wide surgical excision. Both the above mentioned are rare tumours
Slide 13-

PLEOMORPHIC ADENOMA Nasal pleomorphic adenoma contains greater cellularity, most epithelial component are low stromal component and absence of a capsule as compared to major salivary gland tumours. On computed tomography polypoid, pleomorphic adenoma appears to be spherical. Treatment modality is surgery with wide margins to prevent recurrence depending on the size of tumour. Small lesions can be resected with endoscopic endonasal approach and large tumours external lateral rhinotomy, midfacial degloving approach is considered
Slide 14-

BENIGN TUMORS OF NOSE 5) Haemangioma : 1. Capillary Haemangioma (Bleeding Polypus): Soft, dark red, pedunculated or sessile tumour arising from anterior part of nasal septum. Present with recurrent epistaxis and nasal obstruction. Treatment : Local excision with a cuff of surrounding mucoperichondrium.
Slide 15-

BLEEDING POLYPUS
Slide 16-

BLEEDING POLYPUS
Slide 17-

BENIGN TUMORS OF NOSE 5) Haemangioma : 2. Cavernous Haemangioma : Arises from the turbinates on the lateral wall of nose. Treatment : Surgical excision with preliminary cryotherapy.
Slide 18-

BENIGN TUMORS OF NOSE 6) Intranasal Meningoencephlocele : Herniation of brain tissues and meninges through foramen caecum or cribriform plate. Smooth polyp in the upper part of nose between the septum and middle turbinate. Seen in Infants and young children. Mass increases in size on crying or straining. CT scan is essential to demonstrate a defect in the base of skull. Treatment is frontal craniotomy, severing the stalk form the brain, and repair of dural and bony defect. Intranasal mass is removed as secondary procedure after cranial defect has sealed.
Slide 19-

INTRANASAL MENINGOENCEPHLOCELE
Slide 20-

BENIGN TUMORS OF NOSE 7) Chondroma : Arise from the ethmoid, nasal cavity or nasal septum. Pure chondromas are smooth, firm and lobulated. Others may be mixed type fibro-, osteo-, or angiochondromas. Treatment is wide surgical excision Tendency to malignant transformation after repeated interference. 8) Gliomas : Seen in infants and children. Of all the gliomas, 30% are intranasal and 10% both intra and extranasal. An intranasal glioma presents as a firm polyp.
Slide 21-

BENIGN TUMORS OF NOSE 9) Angiofibroma: It is included in nasal tumours because its primary site of origin is supposed to be posterior part of nasal cavity near the sphenopalatine foramen(bounded by palatine bone, horizontal ala of vomer and root of pterygoid process). It a is a locally invasive benign tumor. Juvenile nasopharyngeal angiofibroma: In an adolescent male, profuse recurrent episodes nosebleed suggest juvenile nasopharyngeal angiofibroma until proven otherwise. Angiofibroma consists of varying amount of vascular and fibrous tissues. Vessels do not have muscle coat and are just endothelium lined.
Slide 22-

BENIGN TUMORS OF NOSE 9) Juvenile nasopharyngeal Angiofibroma:
Slide 23-

BENIGN TUMORS OF NOSE 10) Nasal Dermoid : Types: It is of two types-simple and with sinus. Simple dermoid: It presents as a midline swelling over the nasal bones and does not have any external opening. Dermoid cyst with sinus: - External pit: Infants and children present with a pit or a sinus over the dorsum of nose. Hair may be protruding out from the sinus. Intracranial connection: The sinus track communicate intracranially. It presents as widening of upper part of nasal septum with splaying of nasal bones and hypertelorism.
Slide 24-

BENIGN TUMORS OF NOSE 10) Nasal Dermoid : Treatment: Surgery consists of splitting of the nasal bones and removal of cyst along with its extension in the upper part of the nasal septum. Intracranial extension needs associated neurosurgical approach.
Slide 25-

NASAL DERMOID CYST
Slide 26-

NASAL DERMOID CYST
Slide 27-

NASAL DERMOID CYST
Slide 28-

BENIGN TUMORS OF NOSE 11) Nasolabial (nasoalveolar, Klestadt’s) cyst: This squamous epithelium-lined cyst arises from the epithelial rests situated at the junction of globular, lateral nasal and maxillary processes. It lies on the bone and causes an excavation. It is closely attached to the floor of the nose. Globulomaxillary cyst is intrabony. Clinical features: It presents as a smooth and soft bulge in the lateral wall and floor of nasal vestibule anterior to inferior turbinate. Large cyst obliterates the alar facial fold (nasolabial sulcus). The fluctuation and fluid thrill is best felt with one finger in vestibule and second under the lip.
Slide 29-

BENIGN TUMORS OF NOSE 11) Nasolabial (nasoalveolar, Klestadt’s) cyst:
Slide 30-

BENIGN TUMORS OF NOSE Treatment: The cyst is excised through sublabial approach from gingivobuccal sulcus near the midline. A portion of nasal mucosa may be removed because cyst is adherent to it. 11) Nasolabial (nasoalveolar, Klestadt’s) cyst:
Slide 31-

BENIGN TUMORS OF NOSE 12. Rhinophyma or potato tumor: This slow growing benign tumor occurs due to the hypertrophy of sebaceous glands in the region of nasal tip. Most of the patients are men past middle age. It is usually seen in long-standing cases of acne rosacea. Patient presents with pink and lobulated mass over the nose with superficial vascular dilation, which gives unsightly appearance to the face.
Slide 32-

BENIGN TUMORS OF NOSE 12. Rhinophyma or potato tumor:
Slide 33-

BENIGN TUMORS OF NOSE 12. Rhinophyma or potato tumor: The big tumors can cause nasal obstruction and obstructed vision. Treatment: Paring down of the bulk of tumor may be done with sharp knife or carbon dioxide laser. The raw area may be allowed to re-epithelialize. The complete excision of tumor is usually followed by skin grafting.
Slide 34-

BENIGN TUMORS OF NOSE 13. Glioma: It is a nipped off portion of encephalocele during embryonic development. Most of them (60%) are extranasal and present as firm subcutaneous swellings on the bridge, side of nose or near the inner canthus. Purely intranasal (30%), while 10% are both intra and extranasal. Extranasal gliomas are encapsulated and can be easily removed by external nasal approach. An endoscopic approach was indicated to remove the intranasal gliomas.
Slide 35-

INTRANASAL GLIOMA
Slide 36-

EXTRANASAL GLIOMA
Slide 37-

MALIGNANT TUMORS OF NOSE Primary carcinoma per se is rare. It may be an extension of maxillary or ethmoid carcinoma Squamous cell variety, adenoid cystic carcinoma or an adenocarcinoma. They are usually friable, have a granular surface and tend to bleed easily.
Slide 38-

MALIGNANT TUMORS OF NOSE 1) Squamous cell carcinoma It may arise from the vestibule, anterior part of nasal septum or the lateral wall of nasal cavity. Most of them are seen in men past 50 years of age. (i) Vestibular: It arises from the lateral wall of nasal vestibule and may extend into the columella, nasal floor and upper lip with metastases to parotid nodes. (ii) Septal: Mostly arises from mucocutaneous junction and causes burning and soreness in the nose. It has often been termed as "nose-picker's cancer. Usually, it is of low grade malignancy. (iii) Lateral wall: This is the site most commonly involved. Easily extends into ethmoid or maxillary sinuses. Grossly, it presents as a polypoid mass in the lateral wall of nose. Treatment is combination of radiotherapy and surgery.
Slide 39-

MALIGNANT TUMORS OF NOSE 2) Adenocarcinoma and adenoid cystic carcinoma: They arise from the glands of mucous membrane or minor salivary glands. Mostly involve upper part of the lateral wall of nasal cavity. 3) Lymphoma: Rarely a non-Hodgkin lymphoma presents on the septum.
Slide 40-

MALIGNANT TUMORS OF NOSE 4) Plasmacytoma: Plasmacytoma is an uncommon malignant tumor originating either from plasma cells located in the bone marrow also known as the solitary bone plasmacytoma, Or from plasma cells located outside the bone for e.g. In mucosal surfaces, referred to as the extramedullary plasmacytoma also called the solitary extramedullary plasmacytoma. It shows a preference for the upper respiratory tract, especially the nasal cavity and paranasal sinus. It accounts for less than 1% of head and neck tumours. It predominantly affects males over 40 years.
Slide 41-

MALIGNANT TUMORS OF NOSE 4) Plasmacytoma: Treatment is by radiotherapy followed three months later by surgery if total regression does not occur. Long-term follow up is essential to exclude development of multiple myeloma.
Slide 42-

MALIGNANT TUMORS OF NOSE 5) Malignant Melanoma: Seen in persons about 50 years of age. Both sexes equally affected. Grossly, it presents as a slaty-grey or bluish black polypoid mass. Amelanotic varieties are non pigmented. Within the nasal cavity, most frequent site is anterior part of nasal septum followed by middle and inferior turbinate. Tumour spreads by lymphatics and blood stream.
Slide 43-

MALIGNANT TUMORS OF NOSE 5) Malignant Melanoma:
Slide 44-

MALIGNANT TUMORS OF NOSE 5) Malignant Melanoma: Cervical nodal metastases may be present at the time of initial examination. Treatment is wide surgical excision Radiotherapy and chemotherapy suppress the immune processes and are avoided. A five-year survival rate of 30% can be expected after surgical excision
Slide 45-

MALIGNANT TUMORS OF NOSE 6) Haemangiopericytoma: It is a rare tumour of vascular origin. Age group of 60-70 years. It arises from the pericyte-a cell surrounding the capillaries. It presents with epistaxis. Brisk bleeding may occur on biopsy. The tumour may be benign or malignant but it cannot be distinguished histologically. Treatment is wide surgical excision. Radiotherapy is used for inoperable or recurrent lesions.
Slide 46-

HAEMANGIOPERICYTOMA
Slide 47-

MALIGNANT TUMORS OF NOSE 7) Olfactory Neuroblastoma: It is a tumour of olfactory placode seen in persons of either sex at any age group. It presents as a cherry red, polypoidal mass in the upper third of the nasal cavity. It is a vascular tumour and bleeds profusely on biopsy. Lymph node or systemic metastases can occur. Presently, favoured treatment is surgical excision followed by radiation. Craniofacial resection may be required for tumours of the cribriform plate.
Slide 48-

OLFACTORY NEUROBLASTOMA
Slide 49-

OLFACTORY NEUROBLASTOMA
Slide 50-

OLFACTORY NEUROBLASTOMA
Slide 51-

MALIGNANT TUMORS OF NOSE 8) Sarcomas: Osteogenic sarcoma, chondrosarcoma, rhabdomyosarcoma ,angiosarcoma, malignant histiocytoma are other rare tumours affecting the nose. rare tumours affecting the nose.
Slide 52-

NEOPLASMS OF PARANASAL SINUSES
Slide 53-

NEOPLASMS OF PARANASAL SINUSES OSTEOMAS: Most commonly seen in the frontal sinus discovered incidentally on X-rays Surgical excision for rapidly growing osteomas Complete removal of tumour with its base attachment is done by bicoronal osteoplastic flap technique
Slide 54-

FRONTAL SINUS OSTEOMA
Slide 55-

NEOPLASMS OF PARANASAL SINUSES Ossifying fibroma Histologically it looks similar to fibrous dysplasia. Age: It is seen in young adults. Radiology: The sclerotic bony margin can be seen. Treatment: It can be shelled out easily.
Slide 56-

NEOPLASMS OF PARANASAL SINUSES Ossifying fibroma
Slide 57-

NEOPLASMS OF PARANASAL SINUSES Monostotic Fibrous Dysplasia: In this disease, bone isreplaced by fibrous tissue. The most common site is maxilla followed by ethmoid and frontal sinuses. Clinical features: Patient develops disfigurement of the face, nasal obstruction and displacement of the eye. Treatment: Wide removal (surgical resculpturing) provides good cosmetic and functional results.
Slide 58-

NEOPLASMS OF PARANASAL SINUSES Fibrous dysplasia of Sphenoid bone Patient with (L) proptosis
Slide 59-

NEOPLASMS OF PARANASAL SINUSES Odontogenic Tumors: These rare tumors account for only 1% of all jaw tumors. Odontogenic tumors are a heterogeneous group of lesions of diverse clinical behavior and histopathologic types, ranging from hamartomatous lesions to malignancy. Types: Ameloblastoma (adamantinoma) and calcifying epithelial tumor of Pindborg. Origin: These locally aggressive tumors arise from the odontogenic tissue and usually involve maxillary sinus. Treatment: It is surgical excision
Slide 60-

NEOPLASMS OF PARANASAL SINUSES Odontogenic Tumors:
Slide 61-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Clinical Features: Early: Facial pain, nasal obstruction and epistaxis. Eye and Orbit: Diplopia (double vision) and squint due to involvement of oculomotor nerves and extraocular muscles. Loss of vision due to the involvement of optic. Proptosis due to tumor compression of periorbita (orbital fascia). Epiphora due to involvement of lacrimal duct.
Slide 62-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Clinical Features: Facial numbness due to involvement of branches of infraorbital nerve (CNV2). Facial swelling due to involvement of facial soft tissue Cranial nerves involvement: CN II, III, IV, V1 and V2, VI. Malocclusion, widening of upper alveolus, loose and nonvital teeth due to involvement of upper alveolus. Trismus due to involvement of pterygoid muscles.
Slide 63-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Clinical Features: Neck swelling due to involvement of jugular chain lymph nodes. Deafness. Serous otitis media due to involvement of nasopharynx. Mass: Necrotic intranasal mass and/or alveolar/palatal mass or ulceration.
Slide 64-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Diagnosis: Radiographs: CT scan has replaced plain X-rays, which show opacity of sinus with expansion and destruction of the bony walls. CT scan: Axial and coronal planes show bony and soft tissue extent of tumor and help in the staging of disease Endoscopy: Endoscopy of the nose and maxillary sinus provides not only detailed examination but also facilitates an accurate biopsy.
Slide 65-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Diagnosis: 4. Biopsy: Biopsy is taken from the growth in the nose or mouth. In early suspected cases, sinus may be explored through Caldwell-Luc operation but preferred approach is endoscopic intranasal. Direct visualization of the tumor site helps in staging.
Slide 66-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES
Slide 67-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Nasal Mass
Slide 68-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Cheek Swelling
Slide 69-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Alveolar & palatal swelling
Slide 70-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Ohngren’s classification: Ohngren’s line is an imaginary line (OL), which extends between medial canthus and the angle of mandible, divides the maxilla into two regions anteroinferior (AI) and posterosuperior (PS). AI growths are easy to manage and have better prognosis than PS tumors
Slide 71-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Lederman’s classification: Two horizontal lines of Sebileau, one passing through the orbit floors (I) and other through antral floors (II), divide the area into three regions: 1)Suprastructure (SS), 2)Mesostructure (MS), and 3)Infrastructure (IS). 4)The vertical line (III) at the plane of medial wall of orbit separates ethmoid sinuses and nasal fossa from the maxillary sinuses
Slide 72-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES
Slide 73-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Staging of cancer of nose and paranasal sinuses
Slide 74-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: T1 & T2: surgery or radiotherapy T 3: surgery + radiotherapy T4 : surgery + radiotherapy+ chemotherapy
Slide 75-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Maxillary Sinus Surgery: It is the mainstay therapy. Complete radical maxillectomy includes removal of maxilla along with the nasal bone, the ethmoid sinus, and in some cases pterygoid plates. It is adequate when tumor is confined to maxilla, or extends to facial soft tissues, palate, or anterior orbit. But without invasion of the ethmoidal roof, posterior orbit, or pterygoid region- Weber-Ferguson incision.
Slide 76-

WEBER-FERGUSON’S INCISION It starts at the upper lip philtrum on the operative side and goes up to the columella. It continues round the margin of the ala and up the lateral border of the nose. Near the medial canthus of eye it turns laterally in a rounded fashion to go 5 mm below the lower lid margin
Slide 77-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Maxillary Sinus Radiotherapy: It is given either before or after surgery. Curative radiotherapy or chemoradiation may make the inoperable tumors operable. Neutron beam irradiation is most suited to adenoid cystic carcinomas. Preoperative radiotherapy: A full course of preoperative radiotherapy is followed 4–6 weeks later by total or extended maxillectomy.
Slide 78-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Maxillary Sinus Radiotherapy: Indications of postoperative radiotherapy - Large tumors, Positive margins Perineural or perivascular invasion Lymph node metastasis. Adverse affects of radiotherapy – 5,800 rad: Severe panophthalmopathy with severe corneal ulceration in 100% cases. 2,800–5,400 rad: Cataracts and visual disturbances in 86% cases.Prognosis Overall, 5-year survival is about 30%.
Slide 79-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Ethmoid Sinus Early cases: Preoperative radiotherapy, followed by total ethmoidectomy through lateral rhinotomy approach. Late stages: Craniofacial resection, when cribriform plate is involved, exposes anterior cranial fossa and facilitates total exenteration of the growth in one piece. Prognosis Overall, 5-year survival is about 30%.
Slide 80-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Frontal Sinus: It is uncommon and usually seen in males of 40–50 years age group. Presenting features: Pain, swelling of the frontal region and swelling above the medial canthus (erosion of floor of frontal sinus). Treatment: Preoperative radiation followed by surgery, which includes removal of frontal and ethmoid sinuses and orbital exenteration. This neurosurgical approach resects the dura of anterior cranial fossa.
Slide 81-

MALIGNANT NEOPLASMS OF PARANASAL SINUSES Sphenoid Sinus: Very rare. Clinical features similar to the inflammatory lesions of sphenoid sinus. CT and MRI scan and biopsy through sphenoidectomy confirm the diagnosis and extent of disease. Treatment: Radiotherapy is the mainstay of treatment.
Slide 82-

THANK YOU

User Presentation
Related Presentations

ANATOMY OF PHARYNX

By: HarjitpalSingh
Views: 8155

Physiology of Hearing and Equilibrium

By: HarjitpalSingh
Views: 970

TUMORS OF NASOPHARYNX

By: HarjitpalSingh
Views: 4607

Esophagus and Disorders

By: HarjitpalSingh
Views: 3132

Diseases of External Ear

By: HarjitpalSingh
Views: 4402

Unilateral Vocal Cord Paralysis

By: FrankMarco
Views: 1399

Anatomy of External and Middle Ear

By: sfadfasds
Views: 1669

Herpes Simplex Virus

By: bmb1029
Views: 1913

Clinical Management of Head and Neck Cancer

By: yourdoctors
Views: 1433

OTALGIA

By: yakoutent
Views: 2111

HarjitpalSingh

About : Associate Professor (ENT) at Dr Radhakrishnan Govt Medical College, Hamirpur(H P)
Occupation : Medical Professional
Specialty : MD
Country : India
Website :

HEALTH A TO Z