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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 32  |  Issue : 4  |  Page : 408-410

Malignancy of the maxillary antrum: A case report


1 Department of Oral Medicine and Radiology, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Riyadh, Kingdom of Saudi Arabia
4 Dental Public Health, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia

Date of Submission21-Jul-2020
Date of Decision12-Oct-2020
Date of Acceptance15-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Prof. Annette M Bhambal
Department of Oral Medicine and Radiology, Peoplefs College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_153_20

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   Abstract 


Malignant tumor of the maxillary sinus is an uncommon tumor of the head and neck. It is a destructive lesion involving the oral and paranasal sinuses. Since it remains confined to the antral region and produces no symptoms, it is usually diagnosed at an advanced stage and has a very poor prognosis and survival rate. We report a case, of a patient who presented with a large painless swelling in the left maxillary region for 3-4 months. Unfortunately, as the tumor was in the advanced stage and involved vital structures, only supportive management could be provided. As the symptoms of malignancy in the maxillary sinus can be non-specific, it can result in late diagnosis and poor prognosis. This case report highlights the necessity of comprehensive knowledge of sinus pathologies for a maxillofacial physician to arrive at an early diagnosis and help for a better prognosis.

Keywords: Malignancy, maxillary antrum, tumor


How to cite this article:
Bhambal AM, Bhambal A, Ingle E, Ingle NA. Malignancy of the maxillary antrum: A case report. J Indian Acad Oral Med Radiol 2020;32:408-10

How to cite this URL:
Bhambal AM, Bhambal A, Ingle E, Ingle NA. Malignancy of the maxillary antrum: A case report. J Indian Acad Oral Med Radiol [serial online] 2020 [cited 2021 Jan 27];32:408-10. Available from: https://www.jiaomr.in/text.asp?2020/32/4/408/305269




   Introduction Top


Antral malignancies are comparatively rare neoplasms of the head and neck region. They constitute 0.2% of all malignant tumors and only 1.5% of all head and neck malignant neoplasms.[1] About 60%-70% of these carcinomas occur within the maxillary sinus while the rest (12%-25% in the nasal cavity, 10%-15% in the ethmoid, and 1% in the sphenoid/frontal sinuses) are found in the nasal and other paranasal sinuses.[2] Asian countries have reported a very high rate of incidence with predominance in males in the 5th to 6th decade of life.[3] Tobacco, some chemicals, and viruses are believed to be the major risk factors. They usually present as asymptomatic, large, slow-growing lesions that remain confined to the maxillary sinus and incurs a very poor prognosis.[4],[5] Therefore, it is mandatory for the maxillofacial physician to have comprehensive knowledge of sinus pathologies in order to arrive at an early diagnosis and better prognosis.

Clinical Findings

A 35-year-old woman presented to the department at Oral Medicine and Radiology, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, complaining of a large, persistent swelling in the left cheek region since 4 months which had initially started as a small grain-sized swelling. She also complained of continuous nasal discharge which was watery to mucoid in nature with foul smell. There was difficulty in breathing and hyposomia from the left nasal orifice for 4 months. There was a disturbance of vision on the left side. History revealed the extraction of the upper posterior teeth due to the swelling 2 months back. She was a tobacco and betel nut chewer, about two pouches a day, for 2 years. Extra-oral examination showed that the swelling was approximately 11 x 9 cms in its greatest diameter. The superior and inferior extent was from the infra-orbital margin of the left eye to the corner of the mouth and anteroposterior extent was from the left nasolabial fold to 3 cms in front of the tragus of the ear. It was round in shape and the skin over the surface was shiny. The nose was deviated to the right side with obliteration of the left nasolabial fold. There was drooping of the left upper lip with paraesthesia over the left upper lip, cheek, and ala of the nose. On palpation, the swelling was firm to hard and non-fluctuant accompanied with tenderness. Two left submandibular lymph nodes were palpable which were fixed; hard and non-tender [Figure 1]. Intraoral examination showed obliteration of the left labial and buccal vestibule with the mesial- distal extent from 22 to 28. There was an expansion of the buccal cortical plate in the region of 24, 25, and 26 towards the buccal vestibule. The patient was unable to occlude on the left side. The color of the swelling was red, and it appeared stretched, lobulated, and ulcerated. On palpation, the swelling was firm, fluctuant, fixed, and lobulated. The mucosa over the swelling was blanched, stretched, and indurated extending from the alveolar mucosa to the left maxillary sinus. There was grade I mobility in 27 and 28 [Figure 2]. A provisional diagnosis of malignancy of the maxillary antrum was made. Differentials included chronic sinusitis of the maxillary antrum, mucous retention cyst, odontogenic cyst, osteomyelitis, deep fungal infection, and granulomatous diseases.
Figure 1: Extra Oral Photograph

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Figure 2: Intra Oral Photograph

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Diagnostic Assessment

Radiographic investigations included paranasal sinus view (PNS) and a computed tomography (CT) scans. Radiographic evaluation showed a large heterogeneously enhancing destructive mass involving the left maxillary antrum measuring 7.8 × 5.7 × 8.0 cm in size [Figure 3]. The lesion revealed extensive destruction of almost all the walls/margins of left maxillary sinus with extensive invasion into the adjoining regions. There was also rarefaction and destruction of the nasal septum with subsequent infiltration into the right nasal cavity and destruction of the middle concha. The mass had infiltrated into the subcutaneous fat plane of the left cheek. The left parotid gland and the major blood vessels at the carotid triangle were preserved. However multiple enlarged conglomerates enhancing lymph nodes of the upper jugulodigastric group (level II) were involved. Based on the clinical findings and radiological investigations the final diagnosis of Carcinoma of the left maxillary antrum was made. We explained the condition to the patient and advised incisional biopsy to get sufficient histological details of the tumor.
Figure 3: Computed Tomography – Coronal and Axial View

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Therapeutic intervention

A multidisciplinary treatment approach including surgery and chemoradiation was planned.

Follow-up and outcomes

The patient refused the treatment and lost to follow-up after the diagnostic procedure.


   Discussion Top


The oral and pharyngeal malignant lesion is the sixth most common malignancy in the world and the third most common malignancy in India.[6] However, malignancies of the maxillary antrum are rare and fatal. Paranasal sinus carcinomas constitute only about 3% of head and neck cancers of which 80% occur in the maxillary antrum and about 60–90% of these are diagnosed as squamous cell carcinomas.[7],[8] Carcinoma of the maxillary sinus poses a tough challenge to the oncologists and maxillofacial surgeons. They are rare in occurrence and prognosis is very poor. Paraesthesia is a germane sign of malignancy or post-surgical nerve damage.[9] These lesions are extremely invasive. In this case, the lesion had extensive destruction of almost all the walls/margins of left maxillary sinus with extensive invasion into the adjoining regions up to the middle cranial region which is a classical finding in advanced tumors. CT and Magnetic resonance imaging (MRI) are the investigations of choice in such situations. However, in our case, the patient was not willing to do an MRI. CT of maxillary antrum carcinoma was done for visualization of the invasion of structures beyond the site of origin. The management of head and neck cancers involves TNM (tumor, nodes, metastases) staging with the aid of CT or magnetic resonance imaging.[10] Following the classification of malignancy, the oncologist and surgeon can determine the type of treatment that is feasible.

Patient perspectives

Our patient was not convinced for the invasive treatment (surgery and/or chemoradiation) because of the life-threatening form of the disease and the potential therapeutic complications.


   Conclusion Top


This report is a rare case of malignancy involving the maxillary antrum, in which the patient had ignored the different symptoms, as they can be nonspecific in different stages of disease progression. She was cooperative for a limited investigatory approach and denied the treatment options. Early diagnosis of antral carcinomas is possible for oral physicians if they carefully assess the symptoms and select the precise imaging modalities like CT and MRI. Patient education and follow-up is a greater challenge in advanced cases. Though we systematically approached the problem, our patient refused the treatment. This report insists Oral Medicine and Maxillofacial Radiology training should aim for an adequate level of knowledge and skills in interpreting patient's symptoms and analyzing the advanced imaging modalities for the early diagnosis of the rare and serious diseases involving the maxillofacial region.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that their name will not be published, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Nuñez F, Suarez C, Alvarez I, Losa JL, Barthe P, Fresno M. Sino-nasal adenocarcinoma: Epidemiological and clinico-pathological study of 34 cases. J Otolaryngol 1995;22:86-96.  Back to cited text no. 1
    
2.
Fukuda K, Kojiro M, Hirano M, Hyams VJ, Heffner D. Predominance of squamous cellcarcinoma and rarity of adenocarcinoma of maxillary sinus among Japanese. Kurume Med J 1989;36:1-6.  Back to cited text no. 2
    
3.
Sharma S, Sharma SC, Singhal S, Mehra YN, Gupta BD, Ghoshal S. Carcinoma of the maxillary antrum — A 10 year experience. Indian J Otolaryngol 1991;43:191-4.  Back to cited text no. 3
    
4.
Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: A historicalanalysis of population-based data. Head Neck 2012;34:877-85.  Back to cited text no. 4
    
5.
Roter M, Santos M, Paulo J, Servato S, Cardoso SV, Rogério De Faria P. Squamous cell carcinoma at maxillary sinus: Clinicopathologic data in a single Brazilian institution with review of literature. Int J Clin Exp Pathol 2014;7:8823-32.  Back to cited text no. 5
    
6.
Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors for squamous cell carcinoma of the oral cavity in young people-A comprehensive literature review. Oral Oncol 2001;37:401-18.  Back to cited text no. 6
    
7.
Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of mouth cancer: A review of global incidence. Oral Dis. 2000, 6:65-74.  Back to cited text no. 7
    
8.
Myers LL, Nussenbaum B, Bradford CR, Teknos TN, Esclamado RM, Wolf GT. Paranasal sinus malignancies: An 18-year single institution experience. Laryngoscope 2002;112:1964-9.  Back to cited text no. 8
    
9.
Vasudevan V, Kailasam S, Radhika MB, Venkatappa M, Devaiah D, Shrihari TG, et al. Well-differentiated squamous cell carcinoma of maxillary sinus. J Indian Acad Oral Med Radiol 2012;24:250-4.  Back to cited text no. 9
  [Full text]  
10.
Manrique RD, Deive LG, Uehara MA, Manrique RK, Rodriguez JL, Santidrian C. Maxillary sinus cancer review in 23 patients treated with postoperative radiotherapy. Otorhinolaryngol 2008;59:6-10.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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