Benign tumors of the paranasal sinuses


The most common benign tumors of the paranasal sinuses are: osteoma and inverted papilloma.

 

Osteomas

 

Osteoma is reported in as many as 3% of computed tomography’s of the head and sinuses. These are benign tumors, built from bone, the most common in the frontal and ethmoid sinuses. Most of them are not growing, does not cause discomfort, does not require treatmen, only observation. Fast growing osteomas, blocking the ostium, causing headaches and other distressing symptoms, should be removed.

 

Selection of the type of surgery depends on the location and size of the tumo. Traditionally, the frontal sinus osteomas were treated with so-called open accesses, requiring cutting of the scalp and face. Today in the Department of Otolaryngology, Medical University of Warsaw, in some cases, the endoscopic surgery, allows removal of the tumor through the nasal cavity. These operations are carried out under general anesthesia.

 

Possible, but fortunately rare complication of this type of operation, is damage of orbital structures, leakage of cerebrospinal fluid and bleeding from the nose. For external access a late complication may be a scar, sensory disturbances and deformation of the forehead.

 

In general, treatments with external access are shorter than those of endoscopic access (through the nose), however length of hospital stay is shorter and post-operative pain is less severe with the use of endoscopic methods.

Regardless of the type of operation, the first day after surgery, the patient wears the dressing (so-called tamponade) to the nose. In external access it is sometimes necessary to keep the drains to rinse the sinus, and the sutures of the skin are removed seven days after surgery. Care and recommendations after endoscopic surgery are almost identical to the endoscopic sinus surgery, but visits are more frequent.

 

Inverted papilloma

 

Paranasal sinuses inverted papilloma is a benign tumor, occurring most commonly in the maxillary sinus. The tumor grows almost exclusively within the paranasal sinuses and nasal cavity, and does not give metastases, but malignant transformation can occur. This means that in its region can develop squamous cell carcinoma, which is a malignant tumor. The most common symptoms associated with growth of the tumor is, growing unilateral nasal obstruction, muco – purulent leakage form nasal cavity.

The examinations that may be used in the diagnosis of this tumor are:

 

  • CT
  • magnetic resonance imaging
  • nasal endoscopy
  • Pathological examination (biopsy of the tumor, the examinaion of removed change), on which basis we have final diagnosis

 

The treatment is surgical removal of the tumor. Choice of access (a method of removing tumor) depends on the size, the location of lesions. Traditionally, these tumors were treated with external access, requiring facial cuts or cuts in the oral vestibule (without cutting the skin of the face). Currently more often intranasal accesses are used, (removal of the tumor through the nasal cavity) under the control of a microscope, or (more often) the endoscope. Operations are performed under general anesthesia and after the surgery is necessary to establish the dressing to the nasal cavity (called tamponade) for 1 to 2 days.

 

Further post-operative care depends on the surgical approach. In some cases, at different times after the operation, there is a regrowth of the tumor, which is why you should apply for regular check-ups to follow the progress of the healing and early detect of possible recurrence. This observation typically takes up to two years after the operation, and only if, after this time is no evidence of recurrence, the treatment can be considered completed.

 

Tomasz Gotlib, MD