Otolaryngology: Tumours of the nose, sinuses and nasopharynx

Tumours of the nose, sinuses and nasopharynx

✓ Nasal and sinus tumours are typically squamous cell carcinomas (SCC) and metastasize to the lymph nodes of the neck. They are rare, and often not diagnosed until they have spread to surrounding structures.

Aetiology

Tobacco and alcohol are important aetiological factors. Men are more commonly affected. One of the risk factors for development of adenocarcinoma of the maxillary antrum is exposure to the resins produced by hardwoods and woodworkers are at increased risk. Take a careful occupational history. Nasopharyngeal Carcinoma (NPC) is rare in Europe but relatively common in the Far East in general and in southern China in particular. The Epstein–Barr virus plays a role in the aetiology of nasopharyngeal malignancy. Dietary factors salted fish and meats may partly explain the increased risk in South China but genetic factors are important as well.

Carcinoma of the maxillary and ethmoidal sinuses

Clinical features

In its earliest stages these tumours cause no symptoms. Blood stained nasal dis- charge and increasing unilateral nasal obstruction should raise suspicion.

Late features are sadly often the presenting features and include:

• Unilateral facial swelling.

• Swelling or ulceration of the gums or palate.

• Epiphora, owing to involvement of the nasolacrimal duct.

• Proptosis and diplopia, due to involvement of the floor of the orbit.

• Pain commonly in the cheek, but may be referred to the ear, head or jaw

• Metastatic neck nodes

Malignant disease of the nasopharynx

Clinical features

• Nasal obstruction and blood-stained nasal discharge.

• Patients may present with conductive deafness. Otitis media with effusion results from Eustachian tube obstruction.

• Invasion of the skull base causes involvement of various cranial nerves, especially nerves V (paraesthesia in the face and corneal anaesthesia), VI (ophthalmople- gia), IX (pain in the throat, loss of gag reflex), X (hoarseness) and XII (abnormal tongue movement).

• Enlarged cervical nodes may be bilateral.

Other tumours of the nasal region (Fig. 19.1)

Osteomata

Osteomata are benign bony tumours usually in the frontal and ethmoidal sinuses. They are slow growing and cause few symptoms but may eventually call for surgical removal.

Nasopharyngeal angiofibroma

Nasopharyngeal angiofibroma is a rare benign tumour of adolescent boys. It pre- sents as epistaxis and nasal obstruction, and is usually easily visible by posterior rhi- noscopy. Being highly vascular, the tumour is locally destructive and extends into the surrounding structures. Diagnosis is confirmed by MR scanning.

Malignant granuloma

Though not truly neoplastic, malignant granuloma is a sinister condition character- ized by progressive ulceration of the nose and neighbouring structures. This is prob- ably a variant of lymphoma.

Malignant melanoma

Malignant melanoma is fortunately rare in the nose and sinuses.

Treatment is by radical surgery but the prognosis is extremely poor.

Treatment of nasal and sinus tumours

• Treatment of nasopharyngeal cancer is mainly by radiotherapy. Surgery may be needed for late disease and for neck metastases.

• Antro-ethmoidal tumours may be too far advanced for curative treatment at presentation. A combination of surgery and radiotherapy offers the bestchance. Total maxillectomy (with exenteration of the orbit if involved) may be needed. This results in a large defect in the hard palate, for which a modified upper denture with an obturator is provided. Even with radical treatment, nasal sinus carcinoma has a poor prognosis, with only about 30% of patients surviving to 5 years.Angiofibroma is treated by surgical removal with a good prognosis

References

1. Flint PW, Francis HW, Haughey BH, Lesperance MM, Lund VJ, Robbins KT, Thomas JR, editors. Cummings otolaryngology: head and neck surgery. 7th ed. Philadelphia: Elsevier; 2021.

2. Watkinson JC, Clarke RW, editors. Scott-Brown's otorhinolaryngology and head and neck surgery. 8th ed. Boca Raton: CRC Press; 2018.

3. Chan Y, Goddard JC, editors. KJ Lee's essential otolaryngology: head and neck surgery. 12th ed. New York: McGraw Hill; 2019.

4. Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 21st ed. New York: McGraw Hill LLC; 2022.

5. UpToDate. Waltham, MA: UpToDate Inc. uptodate.com (Accessed: July 2026).

6. Medscape Drugs & Diseases. New York: WebMD LLC. medscape.com (Accessed: July 2026).

7. American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guidelines. Alexandria, VA: AAO-HNS. entnet.org (Accessed: July 2026).

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