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Benign Tumors of the Nose and Paranasal Sinuses symptoms, treatment

Benign sino-nasal tumors are abnormal groths that do not spread nor invade other parts of the body and they are not life threatening. They are non-cancerous but they are usually surgically removed for prevention and they have recurrence rate as cancerous tumours.

Classification and types:

 Benign Tumors of the Nose and Paranasal Sinuses are classified into:
a. Epithelial
  • Papilloma. 
  • Adenoma.
    Benign-Tumor-Nose-Paranasal-Sinuses

b. Non-epithelial 
  • Hemangioma. 
  • Osteoma.
  • Fibro-osseous lesions. 
  • Chondroma.
  • Neurolemmoma.
Detailed review of Common Benign Tumors

1. Osteoma


Pathology:
Types:
  • Compact (Ivory) osteoma: common in frontal sinus.
  • Cancellous (spongy) osteoma: common in ethmoidal sinus.
Site: It occurs in junction areas between membranous and cartilaginous bone where remnants of embryonal periosteum persist.

Incidence 
  • It is commoner in females than in males.
  • It is common in Middle East area.
Association: multiple osteomata may be associated with intestinal polyposis (Gardner syndrome).

Symptoms:
  • Asymptomatic in most of the cases (discovered accidentally).
  • Painless slowly growing swelling.
  • Manifestations of pressure and encroachment on the surrounding structures e.g. headache, proptosis, mucocele, nasal obstruction, deterioration of vision.
Signs:
  • Hard, well defined swelling.
  • May be seen in the nose.
Investigations:  Plain X ray -C.T.

Treatment: 
  • Surgical excision if symptomatizing.
  • This can be done either externally, or endoscopically.

2. Fibrous dysplasia

Definition: It is not a real tumor. It is an obscure bone disease where normal osseous tissue is absorbed and replaced by fibrous tissue and poorly formed bone trabeculae.
Etiology: Unknown, may be developmental.
Incidence
  • 2.5% of all bony neoplasm.
  • Common in the 1st and 2nd decades.
  • Common in females.
Pathology: 
According to the affected sites, it may be:
  1. Monostotic: single site. In the head and neck, the maxilla is the commonest site.
  2. Polystotic: several sites including long bones, mostly unilateral .It may be associated with cutaneous pigmentation and endocrinal disturbance as precocious puberty, diabetes mellitus or hyperthyroidism (Albright syndrome).
  • The growth tends to slow down after puberty and stops after complete osseous maturity.
  • It does not turn malignant except if irradiated.
  • Histologically, there is a mixture of fibrous and osseous tissue.
Symptoms: 
Painless slowly growing swelling mostly in the maxilla and alveolar process causing:
  • Disfigurement. 
  • Loosening of teeth.
  • Nasal obstruction. 
  • Proptosis.
  • Facial pain and numbness due to involvement of infraorbital foramen.

Signs: 
  • Diffuse, ill defined, non-tender, hard bony swelling.
Investigations: 
  • X-ray: hyperdensity of the facial bones with ground glass appearance.
  • Increased serum alkaline phosphatase.
  • Radioactive bone scan will show an increased uptake in all the affected sites.

Treatment:
  • As the lesion tends to stabilize after puberty, no treatment is indicated unless there are manifestations.
  • Limited trimming is indicated if the mass is disfiguring or causing pressure manifestations.

3. Papilloma

Pathology: Squamous cell papilloma (wart), which arises from skin of vestibule.
Clinically: Pedunculated warty growth.
Treatment: surgical excision.

CT-nasal-tumors


4. Hemangioma

Clinico-pathological types:
a. Capillary hemangioma (Bleeding polypus of septum).
  • It presents as a soft red blue polyp on the nasal septum causing epistaxis.
  • Treatment is by surgical excision with cauterization of the base. Laser may be used.
b. Cavernous hemangioma:
  • Commoner in children. 
  • It arises from the lateral nasal wall especially the area of the inferior and middle turbinates. I
  • t causes epistaxis and sometimes nasal obstruction if large.
  • Treatment is by excision either surgically, by laser or by cryo-surgery.
benign-sinonasal-tumors
c. Multiple familial telangiectasia (Osler-Rendu disease)
  • Congenital vascular malformation of hereditary origin. 
  • It runs in families. It may involve the nose, lips, face, oral mucosa, palate, tongue, pharynx and larynx.
  • It causes recurrent epistaxis
  • It is treated by laser or surgical excision of the affected nasal mucous membrane.

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