3 Oeteoma Osteomas are common incidental finding in frontal sinus x-ray Majority are asymptomatic & do not growSurgery is done for symptomatic osteomas or those that rapidly increase in sizeComplete removal of tumor with its base attachment is done by bicoronal osteoplastic flap technique
8 Ossifying fibroma Synonym: Fibrous dysplasia Normal medullary bone is replaced by abnormal proliferation of fibrous tissue, resulting in distortion & expansion of boneC.T. scan: ground - glass appearance with regions of osteolysis & calcificationTreatment: complete surgical excision
11 Inverted papilloma Locally aggressive sino-nasal tumour Synonyms: Ringertz or Schneiderian papillomaCommon in males between yearsIt arises from the lateral wall of nosePresents as unilateral, friable, pale, pink mass arising from middle meatusDiagnosis made by punch biopsy
12 Inverted papillomaTreatment: medial maxillectomy and en bloc ethmoidectomy by lateral rhinotomy or midfacial degloving.Inverted papilloma has a marked tendency to recur after surgical removal.Squamous cell ca is present in 1015% cases.Radiotherapy is avoided.
27 Late Clinical features Medial spread:Unilateral nasal obstructionUnilateral purulent nasal dischargeEpistaxisUnilateral, friable, nasal massAnterior spread:Cheek swellingInvasion of facial skin
28 Late Clinical features Inferior spread:Expansion of alveolus with dental painLoosening of teeth, poor fitting of denturesSwelling in hard palate or alveolusSuperior spread:ProptosisDiplopiaOcular pain.
29 Late Clinical features Posterior spread:Pterygoid muscle involvement trismusIntracranial spread via:Ethmoids, cribriform plate or foramen lacerumLymphatic spread:Neck node metastases in late stagesSystemic spread: Lungs, bone
38 Ohngren's Classification Ohngren's line: An imaginary plane extending between medial canthus of eye & angle of mandibleSupra structural growths situated above this plane have a poorer prognosisIntra structural growths situated below this plane have better prognosis
40 Lederman’s Classification 2 horizontal lines of Sebileau pass through floors of orbits & maxillary sinus, producing:Suprastructure: ethmoid, sphenoid & frontalsinuses; olfactory area of noseMesostructure: maxillary sinus & respiratorypart of noseInfrastructure: alveolar process
41 T.N.M. Staging T1 = tumor confined to antral mucosa T2 = bone destruction of hard palate / middle meatusT3 = involvement of skin of cheek, floor or medialwall of orbit, ethmoid sinus, posterior antral wall,pterygoid plates, infratemporal fossaT4 = involvement of orbital contents, cribriform plate,frontal or sphenoid sinus, skull base, nasopharynx
42 Treatment T1 & T2 = Surgery or Radiotherapy T3 = Surgery + RadiotherapyT4 = Surgery + Radiotherapy + ChemotherapyEuropeans: pre-operative Radiotherapy ( cGy) surgery after 4-6 weeksAmericans: Surgery post-operative Radiotherapy after 4-6 weeks
43 Surgical Options1. Total maxillectomy (Weber Fergusson incision) = malignancy limited to maxilla2. Radical maxillectomy with orbital exenteration(Weber Fergusson Diffenbach incision) = involvement of orbital fat3. Anterior Cranio Facial Resection (extendedlateral rhinotomy incision) = involvement of cribriform plate, frontal sinus
50 Orbital exenteration indications Involvement of orbital apexInvolvement of extra-ocular musclesInvolvement of bulbar conjunctiva or scleraLid involvement beyond a reasonable hope for reconstructionNon-resectable full thickness invasion through periorbita into retrobulbar fat