Maxillary Carcinoma

Ohngren’s line is a line joining the medial canthus of the eye with the angle of the mandible.

It divides the maxillary sinus into two components: suprastructure (superolateral) and infrastructure (inferomedial).

The location as well as extent of tumor (maxillary carcinoma) has prognostic significance.

Tumors involving the suprastructure of the maxillary antrum have a worse prognosis than those involving the infrastructure.

In paranasal sinus tumors

• Lymphatic spread: Nodal metastases are uncommon and occur only in the late stages of disease. Submandibular and upper jugular nodes are enlarged. Maxillary and ethmoid sinuses drain primarily into retropharyngeal nodes, but these nodes are inaccessible to palpation.
• Systemic metastases are rare. May be seen in the lungs (most commonly) and occasionally in bone.
• Intracranial spread can occur through ethmoids, cribriform plate or foramen lacerum.

Ans. is ‘a’ i.e., Maxillary carcinoma

Paranasal sinus cancer is uncommon and represents only 0^.2 to 0^.8% of all malignancies.

• Cancer of paranasal sinus constitutes 3% of all carcinomas of the aerodigestive tract.
• The majority of paranasal sinus malignancies (50-80%) originate within the maxillary sinus antrum. Malignancies rarely occur within the other sinuses and originate in the ethmoid, frontal, and sphenoid sinuses in 10%, 1% and 1% respectively.
• The cause of parasinus malignancy is unknown. However several risk factors have been associated and therefore it is seen more commonly in people working in hardwood furniture industry, nickel refining, leather work, and manufacturer of mustard gas.
• More than 80% of the malignant tumours are of squamous cell variety. Rest are adenocarcinoma, adenoid cystic carcinoma, melanoma, and various type of sarcomas.
• Workers of furniture industry develop adenocarcinoma of the Ethmoids and upper nasal cavity. While those engaged in Nickel refining get squamous cell and Anaplastic carcinoma.

Clinical features for maxillary carcinoma

• It is seen more commonly in the 7^th decade of life.
• Males are affected more commonly than females.
• Early features of maxillary sinus malignancy are nasal stuffiness, blood-stained nasal discharge, facial paraesthesias or pain and epiphora. These symptoms may be missed or simply treated as sinusitis. Late features will depend on the direction of spread and extent of growth.
• Medial spread to nasal cavity gives rise to nasal obstruction, discharge and epistaxis. It may also spread into anterior and posterior ethmoid sinuses and that is why most antral malignancies are antroethmoidal in nature.
• Anterior spread causes swelling of cheeks.
• Inferior spread leads to expansion of alveolus with dental pain, loosening of teeth, poor fitting dentures, ulceration of gingiva.
• Superior spread invades the orbit causing proptosis, diplopia, ocular pain and epiphora.
• Posterior spread is into pterygomaxillary fossa, pterygoid plate and the pterygoid muscles causing trismus.
• Lymphatic spread in maxillary carcinoma is rare and occurs only in the late stages.
• Most commonly involved lymph node is submandibular lymph node followed by jugular nodes.

Treatment of maxillary carcinoma

• For squamous cell carcinoma, the treatment of choice is a combination of radiotherapy and surgery.
• Radiotherapy can be given before or after surgery. Very often, a full course of pre-operative telecobalt therapy is given, followed 4 – 6 weeks later by surgical excision of the growth by total or extended maxillectomy.