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31 Cards in this Set

  • Front
  • Back
The paranasal sinuses develop from which embryonic tissues?
mesenchymal
ectodermal
What are the following margins for tumor spread in the paranasal sinuses?

Anterior
Superior lateral
Inferior lateral
Posterior lateral
Inferior posterior midline
Superior posterior midline
Superior
Anterior - frontal sinus and septum
Superior lateral - orbits and supraorbital dura
Inferior lateral - pterygopalatine fossa
Posterior lateral - Fossa of Rosenmuller
Inferior posterior midline - clivus and arch of C1
Superior posterior midline - Sella
Superior - cribriform plate
What is the most common malignancy type of the paranasal sinuses?
squamous cell ca
What is the most frequent site of malignant tumors of the paranasal sinuses?
Maxillary sinus (55%)
Nasal passage (35%)
Ethmoids (10%)
Frontal/sphenoid - rare (<1%)
What is the most common presenting symptom/sign of paranasal sinus tumors? What is the 2nd mc?
1st mc = nasal obstruction
2nd mc = neck lymphadenopathy
What are the presenting S&Sx of the following areas in pts with paranasal sinus tumors?

Nasal
Facial
Ocular
Auditory
Oral
Constitutional sx:
Nasal - discharge, congestion, epistaxis, disturbance of smell
Facial - infraorbital nerve hypoesthesia, pain
Ocular - unilateral epiphoria, diplopia, fullness of lids, pain, vision loss
Auditory - hearing loss, otalgia, aural fullness
Oral - pain involving the maxillary dentition
Constitutional sx - fever, weight loss, malaise
What are social and environmental exposures/factors which predispose pt's to:
1) SCCA of paranasal sinuses

2) Adenocarcinoma of paranasal sinuses
1) SCCA of paranasal sinuses
- nickel, aflatoxin, chromium, mustard gas, volatile hydrocarbons, and organic fibers found in the wood, shoe and textile industries.

2) Adenocarcinoma of paranasal sinuses
- wood dust, woodworking, furniture making and leather work
What is thought to be the pathophys of HPV-induced cancer?
Viral E6 and E7 particles caused inhibition of tumor suppressor proteins
You see a nasal cavity mass and have the pt perform Valsalva maneuver under direct visualization. There is expansion of the mass during the Valsalva. What does this imply?
Intracranial or major venous extension
Often on CT imaging of inverted papillomas, what can be found at the site of origin?
Hyperostotic bone
Histopathologicic Markers on Bx for Olfactory Groove Cancers

What are the markers for the following cancers?
ENB (esthesioneuroblastoma)
SNUC (sinonasal undifferentiated carcinoma)
SNEC (sinonasal neuroendocrine carcinoma)
ENB - CHR (chromogranin), SYN (synaptophysin), absent CK (epithelial markers) and EMA (epithelial membrane Ag)
SNUC - CK, EMA, NSE (weak neuron specific enolase)
SNEC - express one or more of the neuroendocrine markers diffusely - CHR, NSA, SYN, CK
What are paransal sinus osteomas, where are the mc locations and how are they managed?
Osteoma's are one of the benign neoplasms that usually are not destructive (can be expansive)
Location - mc frontal sinus > ethmoid > maxillary sinus
Management - observation, obstructing sinus outflow tract or impinging on dura or rapidly growing.
What are the three types of sinonasal papillomas? List most common first
Septal papilloma (50%)
Inverted papilloma (47%) - from lateral nasal wall
Cylindrical papilloma (3%) - from lateral nasal wall
What percent of inverted papillomas transform to SCCA?
5-9%
How does angiofibroma present symptomatically, on endoscopy and on CT/MRI?
JNA = juvenile nasopharyngeal angiofibroma

Presentation - usually unilateral bleeding in a teenage boy and/or unilateral nasal cavity mass
Endoscopy - clear vascular lesion originating from the sphenopalatine area (do not bx in clinic!!!)
CT/...
JNA = juvenile nasopharyngeal angiofibroma

Presentation - usually unilateral bleeding in a teenage boy and/or unilateral nasal cavity mass
Endoscopy - clear vascular lesion originating from the sphenopalatine area (do not bx in clinic!!!)
CT/MRI - expansion of pterygopalatine fossa
What is the tx for JNA?
surgical resection AFTER embolization.
endoscopic, midfacial de-gloving and transfacial (from lease invasive to most) approaches can be performed.
What is the DDx for pediatric paranasal sinus lesions?
Embryonal rhabdomyosarcoma (most common pediatric sinus cancer)
Nasal glioma
JNA
Encephalocele
List the factors associated with predicting survival for paranasal sinus cancer
Histolical findings of primary tumor
1) worst - mucosal melanoma
2) best - minor salivary gland tumors, low-grade sarcomas
T-stage
Presence and extent of intracranial involvement
Resection margins
Previous radiation
Previous incomplete resection (initial misdiagnosis)
Nodal dz
DIstant mets
When is radiation used in treatment of benign paransal sinus tumors?
Reserved for symptomatic tumors in nonsurgical candidates or for radiation-sensitive tumors such as plasmacytomas.
What is Ohngren's line?
An imaginary line drawn from the medial canthus to the ipsilateral angle of the mandle. 
Tumors anterior/inferior to this line have a better prognosis.
An imaginary line drawn from the medial canthus to the ipsilateral angle of the mandle.
Tumors anterior/inferior to this line have a better prognosis.
What is the overall 5-year survival rate for all pts undergoing craniofacial resection for sinonasal cancer?
50%
What are the indications for endoscopic transnasal transcribriform craniofacial resection?
Initially though to be only for those pts with low-stage dz with no intracranial involvement; however, recent results with endoscopic dural and intradural resections have shown promise for highly experienced skull base surgery programs.
What are the reconstructive goals for skull base surgery?
Goal is to completely separate the cranial cavity from the sinonasal tract, eliminate dead space and preserve neurovascular and ocular function.
Name a few intranasal vascular tissue flaps.
NSF - nasoseptal flap (sphenopalatine artery)
ITF - inferior turbinate flap (inferior turbinate artery)
MTF - middle turbinate flap (middle turb artery)
Name a few regional vascular tissue flaps.
PCF - pericranial flap (supraorbital and supratrochlear arteries) - primary option for a vascular flap!
TPFF - temporoparietal fascial flap (superficial temporal artery)
Intraoperative Complications of Paranasal Sinus Tumor Tx

Where is the most common site of venous bleeding?
cavernous sinus or pterygoid plexus
Intraoperative Complications of Paranasal Sinus Tumor Tx

Where is the most common site of arterial bleeding?
ethmoid or internal maxillary arteries
Intraoperative Complications of Paranasal Sinus Tumor Tx

Which nerve is most commonly damaged in intradural nerve injury?
CN2
Intraoperative Complications of Paranasal Sinus Tumor Tx

Which nerve is most commonly damaged in extradural nerve injury?
CN1
Intraoperative Complications of Paranasal Sinus Tumor Tx

Where is the most common site of positive margins?
lateral supraorbital dura
Which paranasal sinus tumor has small, round blue cells?
Sinonasal neuroendocrine carcinoma (SNEC)