Malignant Tumors of the Sinuses Clinical Presentation

Updated: Oct 18, 2022
  • Author: Karen Y Choi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Presentation

History

It is important to obtain a thorough history; this includes a social and employment history to assess for risk factors.

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Physical Examination

A complete head and neck exam should be performed, with close attention to the cranial nerves. Nasal endoscopy can be performed to visualize any lesions or to obtain biopsies.

Initial presenting symptoms include epistaxis, nasal obstruction, recurrent sinusitis, cranial neuropathy, sinus pain, facial paresthesia, proptosis, diplopia, or an asymptomatic neck mass. Often, these mimic signs of conditions more common and less serious than malignant tumors of the sinuses. The patient often ignores early symptoms, or the clinician may minimize them, treating early-stage malignancies as infectious diseases. By the time ominous signs and symptoms (eg, severe intractable headache, visual disturbances) occur, the neoplasms are advanced and require complex management.

In addition to malignant neoplasms causing local destruction of the tissues, infectious diseases of the sinuses (eg, mucormycosis in diabetes) can cause similar destruction. In addition, certain autoimmune diseases (eg, granulomatosis with polyangiitis) can also manifest with new growth and malignant behavior.

Finally, benign growths from outside the sinonasal tract in adjacent areas may lead to aggressive signs and symptoms and require radical and destructive therapy. Meningiomas may grow into the sinuses, and orbital tumors may extend into adjacent paranasal sinuses. Even benign conditions, such as juvenile angiofibromas or nasal gliomas, may lead to death if not recognized and appropriately treated.

This article limits itself to sinonasal malignancies (SNMs) that arise from host tissues and are considered locally invasive, destructive, and possibly metastatic.

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