Tumors of the paranasal sinuses

Tumors of the paranasal sinus cavities grow silently for months. They are rare lesions, which usually present late in the course of disease.

Diagnosis is complicated because these lesions symptomatic only when erosion into adjacent structures occurs. In addition, the symptoms are identical to those of benign sinonasal disease which delays definitive diagnosis.

In patients with a history of exposure to known paranasal sinus carcinogens, it is important for otolaryngologists to keep a high index of suspicion when treating patients with sinonasal symptoms.

Suspicious lesions should be biopsied and appropriate imaging studies obtained in order to avoid prolonged delay in definitive diagnosis.

Most lesions are at an advanced stage at the time of definitive diagnosis. However, in recent years the widespread use of systematic nasal endoscopy and high resolution computed tomography have contributed to earlier diagnosis.

The primary cause of death from paranasal sinus malignancies is failure of local control. Adequate surgical treatment requires wide en bloc surgical resection of the tumor and adjacent structures.

The high mortality rate and poor prognosis associated with these tumors is related to late diagnosis secondary to the early symptomatic latency of these lesions.

Tumors of the paranasal sinuses are uncommon in the general population. The incidence of sinonasal carcinoma is about one case per 100,000 people per year, which represents 3% of the upper aerodigestive tract malignancies and less than 1% of all malignancies in the body.

Males are affected two to three times more often than females, and most patients are in their fifth to seventh decade at the time of diagnosis. The majority of paranasal sinus tumors arise in the maxillary sinus (80%). Twenty percent arise in the ethmoid sinuses, and the remainder (less than 1%) originate in the frontal and sphenoid sinuses.

Eighty percent of these lesions are squamous cell carcinomas; fifteen percent are adenocarcinomas, with the remaining five percent composed of all other types.