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1、,單擊此處編輯母版標(biāo)題樣式,*,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),Tumor of Nasal cavity and Paranasal sinuses,Department of Otolaryngology,Affiliated Ninth People s Hospital of Shanghai Jiaotong University,School of Medicine,Wang Peihua,Tumor of Nasal cavity and Par,1,Benign,Tumor of Nasal cavity and Paranasal sinuses,B

2、enign Tumor of Nasal cavity,2,Papilloma,（,p107),etiology unknown,human papilloma virus,HPV,Papilloma （p107),3,Pathology:,Hard type,1 small,hard,gray,local,single,mulberry-shaped,2 usually located in nasal vestibule,anterior nasal septum,hard palate,3 squamous epithelium,Pathology:,4,Soft type,compar

3、atively large,soft,red,diffuse growth,with pedicle/wide base.,Schneiderian membrane,Inverting papilloma recurrent tendency malignant change multiple growth and histoclasia,Soft type,5,Clinical manifestation,40y,malefemale,Unilateral,Persistent,progressive nasal obstruction,mucopurulent discharge,som

4、etimes with blood,Headache and dysosmia,Rhinosinusitis and nasal polyps,Clinical manifestation40y,ma,6,Examination,with different size and hardness,Polypoid,red-gray,scobinate,easy-bleeding,usually located in nasal wall.,Examination,7,Treatment,radical resection,lateral rhinotomy/sublabrum approach,

5、Maxillectomy+ethmoidotomy(if necessary),Endoscopic Sinus Surgery.,Treatment,8,Malignant Tumor of Nasal cavity and Paranasal sinuses,（,p109,）,Malignant Tumor of Nasal cavi,9,Statistics,:,ENT:20%in total Malignant Tumor.,Nasal and sinonasal MT:21.74%-49.22%in ENT MT.,Male:female=31,，,predilection age:

6、40,60,y.,Statistics:,10,Features:,predilection site is maxillary sinus(,6080%,),1/3 with ethmoid sinus MT.,ethmoid sinusfrontal sinussphenoid sinus.,primary tumormetastatic tumor.,advanced stage primary stage,invasion of adjacent tissue(orbit,skull base),Features:,11,Etiological factor,Immunocomprom

7、ice,Stimulation of chronic inflammation,Canceration of benign tumor,Expo,sure to oncogens,Etiological factor Immunocompr,12,Pathology,SCC(35%-66%),，,other:adenocarcinoma(only in,paranasal sinuses,),lymphoepithelial carcinoma,transitional epithelioma,BCC,sarcoma,.,Carcinoma Sarcoma(3.5-9.6:1).,Most o

8、f sarcoma is malignant lymphoma(60%).,PathologySCC(35%-66%)，other:a,13,clinical manifestation,1,Nasal obstruction,2,Epistaxis or hemic secretion,clinical manifestation,14,Carcinoma of maxillary sinus,anterointernal,：,odontic symptoms in early stage,prognosis,anteroexternal,：,posterointernal,：,orbit/

9、skull base,prognosis,posteroexternal,：,orbit/,pars zygomatica,prognosis,Carcinoma of maxillary sinusan,15,Carcinoma of maxillary sinus,Clinical manifestation:,1,.,Unilateral nasal discharge with pus and blood,2.Unilateral ache and numbness of buccal region,3.Unilateral progressive nasal obstruction,

10、4.Unilateral Odontalgia and odontcseisis of superior teeth,Carcinoma of maxillary sinus C,16,Carcinoma of maxillary sinus,1.,Oncoides,of,buccal region,2.Eye symptom,3.,Oncoides,of hard palate,4.Difficult in opening mouth,5.Basicranial invasion,6.Cervical lymphnode metastasis,Clinical manifestation o

11、f advanced stage:,Carcinoma of maxillary sinus1.,17,Carcinoma of,ethmoid sinus,medial orbital wall,proptosis,displacement of globe,diplopia,hypopsia,swelling/diabrosis of endocanthion/nasal root,Usually caused by Carcinoma of maxillary sinus,minority is primary(,epithelioma,/sarcoma).,Carcinoma of e

12、thmoid sinusmedi,18,local sore pain,epistaxis,oncoides,of forehead and superior/,inner,orbital,margin,displacement of globe,Carcinoma of frontal,sinus,local sore pain,epista,19,Carcinoma of sphenoid,sinus,Primary,secondary,Carcinoma of sphenoid sinusPri,20,1.Case history and signs:40y,unilateral,2.A

13、nterior-posterior nasal cavity examination:neoplasm,diabrosis,necrotic tissue,bleeding.,Posterior rhinoscopy,3.Nasal endoscopy,Diagnosis,1.Case history and signs:40y,21,4.Imaging detection:X-ray,CT scan,MRI,and so on.,5.Biopsy,6.TNM classification,（,UICC,1997),4.Imaging detection:X-ray,C,22,Treatmen

14、t,key point-first time treatment,chemotherapy/radiotherapy+surgery,surgery+chemotherapy/radiotherapy,Combined modality therapy(based on surgery),Treatment Combined modality th,23,modus operandi:,1.lateral rhinotomy(Moure incision),2.total maxillectomy(Weber-Fergusson incision),3.“T”incision in nasal

15、 root(Presinger incision),4.external frontal sinusotomy(Lynch incision),5.sublabial approach(Denker incision),6.midfacial degloving,bined craniofacial approach,modus operandi:,24,Radiotherapy:,Simple radical,radi,ation,therapy,sarcoma,u,ndifferentiated,c,arcinoma,palliative radiation therapyadvanced stage,Preoperative radical radiation therapy-60Cobalt,linear accelerator,4-6 weeks,50-60Gy.,Chemotherapy:,Radiotherapy:,25,