Diagnosis and Tnm Classification of Maxillary Sinus Carcinoma

Abstract

In order to detect a malignant lesion in the maxillary sinus at an early stage, the following points should be borne in mind. Suspicion of cancer should be aroused by the presence of continuous bloody nasal discharge, buccal paresthesia, buccal swelling, ocular pain and/or toothache. One should be more suspicious of cancer in the presence of swelling of the lateral wall of the nasal cavity or bulging of the inferior nasal meatus. Radiopacity of the unilateral maxillary sinus should be watched with special attention. In many cases in which the tumour was invisible, a positive result was successfully obtained by a blind punch biopsy through the inferior nasal meatus. X-ray findings are important together with clinical findings, and by using various projections we were able to obtain the expected results.

Our TNM classification of the carcinoma of the maxillary sinus is as follows: T1: Tumour confined to the maxillary sinus, with no evidence of bone involvement.

T2: Tumour causing destruction of the bony wall, with the external periosteum remaining intact as a capsule, and the surrounding tissue not invaded but only compressed. Minimal infiltration into the ethmoid cells and the exophytic tumour in the middle nasal meatus is included in this category. T3: Tumour infiltrating deeply into the surrounding tissue by penetration of the external periosteum.

T4: Tumour extending to the base of skull, the nasopharynx and the maxilla of the opposite side.

The validity and usefulness of our TNM classification have been demonstrated. For example, the radiation effect was remarkably better in T1-2 than in T3-4. Concerning the crude survival rate, there was little difference between the irradiation and operation groups at T1 or T2 but at T3 the results were far worse in the irradiation group alone than in the combined therapy group.