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31 Cards in this Set
- Front
- Back
The paranasal sinuses develop from which embryonic tissues?
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mesenchymal
ectodermal |
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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 |
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What is the most common malignancy type of the paranasal sinuses?
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squamous cell ca
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What is the most frequent site of malignant tumors of the paranasal sinuses?
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Maxillary sinus (55%)
Nasal passage (35%) Ethmoids (10%) Frontal/sphenoid - rare (<1%) |
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What is the most common presenting symptom/sign of paranasal sinus tumors? What is the 2nd mc?
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1st mc = nasal obstruction
2nd mc = neck lymphadenopathy |
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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 |
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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 |
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What is thought to be the pathophys of HPV-induced cancer?
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Viral E6 and E7 particles caused inhibition of tumor suppressor proteins
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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?
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Intracranial or major venous extension
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Often on CT imaging of inverted papillomas, what can be found at the site of origin?
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Hyperostotic bone
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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 |
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What are paransal sinus osteomas, where are the mc locations and how are they managed?
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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. |
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What are the three types of sinonasal papillomas? List most common first
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Septal papilloma (50%)
Inverted papilloma (47%) - from lateral nasal wall Cylindrical papilloma (3%) - from lateral nasal wall |
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What percent of inverted papillomas transform to SCCA?
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5-9%
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How does angiofibroma present symptomatically, on endoscopy and on CT/MRI?
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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 |
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What is the tx for JNA?
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surgical resection AFTER embolization.
endoscopic, midfacial de-gloving and transfacial (from lease invasive to most) approaches can be performed. |
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What is the DDx for pediatric paranasal sinus lesions?
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Embryonal rhabdomyosarcoma (most common pediatric sinus cancer)
Nasal glioma JNA Encephalocele |
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List the factors associated with predicting survival for paranasal sinus cancer
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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 |
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When is radiation used in treatment of benign paransal sinus tumors?
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Reserved for symptomatic tumors in nonsurgical candidates or for radiation-sensitive tumors such as plasmacytomas.
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What is Ohngren's line?
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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. |
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What is the overall 5-year survival rate for all pts undergoing craniofacial resection for sinonasal cancer?
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50%
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What are the indications for endoscopic transnasal transcribriform craniofacial resection?
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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.
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What are the reconstructive goals for skull base surgery?
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Goal is to completely separate the cranial cavity from the sinonasal tract, eliminate dead space and preserve neurovascular and ocular function.
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Name a few intranasal vascular tissue flaps.
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NSF - nasoseptal flap (sphenopalatine artery)
ITF - inferior turbinate flap (inferior turbinate artery) MTF - middle turbinate flap (middle turb artery) |
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Name a few regional vascular tissue flaps.
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PCF - pericranial flap (supraorbital and supratrochlear arteries) - primary option for a vascular flap!
TPFF - temporoparietal fascial flap (superficial temporal artery) |
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Intraoperative Complications of Paranasal Sinus Tumor Tx
Where is the most common site of venous bleeding? |
cavernous sinus or pterygoid plexus
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Intraoperative Complications of Paranasal Sinus Tumor Tx
Where is the most common site of arterial bleeding? |
ethmoid or internal maxillary arteries
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Intraoperative Complications of Paranasal Sinus Tumor Tx
Which nerve is most commonly damaged in intradural nerve injury? |
CN2
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Intraoperative Complications of Paranasal Sinus Tumor Tx
Which nerve is most commonly damaged in extradural nerve injury? |
CN1
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Intraoperative Complications of Paranasal Sinus Tumor Tx
Where is the most common site of positive margins? |
lateral supraorbital dura
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Which paranasal sinus tumor has small, round blue cells?
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Sinonasal neuroendocrine carcinoma (SNEC)
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