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Malignant tumors of the maxillary sinus: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Tumors of the maxillary sinus are otolaryngological diseases that are both within the competence of maxillofacial surgeons (primarily), and in some clinical and anatomical variants, especially those concerning maxillary-ethmoidal mixes, within the competence of rhinologists.
In the vast majority of cases (80-90%), these tumors are epitheliomas; 10-12% are sarcomas, usually occurring in children and young adults. Most often, maxillary cancer originates from the posterior cells of the ethmoid labyrinth or the edge of the alveolar process of the maxilla. In their structure, both epithelial and mesenchymal malignant tumors of the maxillary sinus are identical to those that occur in the nasal cavity.
[ Symptoms of malignant tumors of the maxillary sinus
Symptoms of malignant tumors of the maxillary sinus are extremely varied and depend on the stage and localization of the tumor. The same stages are distinguished as for malignant tumors of the nasal cavity.
The latent stage is asymptomatic and most often goes unnoticed. Only in rare cases is it discovered accidentally during examination of a patient for "polypous ethmoiditis", which is essentially the same "accompaniment" as with cancer of the nasal cavity.
The stage of tumor manifestation at which the tumor, having reached a certain size, can be detected in the superolateral region of the nose or in the region of the lower wall of the maxillary sinus at the edge of the alveolar process or in the retromandibular region.
The stage of tumor extraterritorialization is characterized by the exit of the neoplasm beyond the maxillary sinus.
The famous French otolaryngologist Sebilo describes three clinical and anatomical forms of maxillary sinus cancer. "Suprastructural neoplasms", in the author's terminology, i.e. tumors originating from the ethmoid labyrinth and penetrating the maxillary sinus from above.
The symptoms of malignant tumors of the maxillary sinus are as follows: mucopurulent discharge of dirty gray color with an admixture of blood, often foul-smelling, often - nosebleeds, especially severe with arrosion of the anterior ethmoid artery; progressive unilateral obstruction of the nasal passages, neuralgia of the first branch of the trigeminal nerve, anesthesia of its innervation zones, while palpation of these zones causes severe pain. With anterior and posterior rhinoscopy, the same picture is revealed that was described above for tumors of the nasal cavity of ethmoidal origin. Histological examination in many cases does not give positive results, therefore, with a biopsy or removal of "banal accompanying polyps", histological examination should be repeated several times.
When performing a puncture of the maxillary sinus in this form of cancer, it is usually impossible to obtain any significant evidence in favor of its presence, unless a "vacuum" is detected, or hemolyzed blood enters the syringe during suction. The addition of a secondary infection to an existing tumor of the maxillary sinus significantly complicates the diagnosis, since such patients are diagnosed with chronic or acute purulent inflammation of the sinus, and the true disease is discovered only during surgery.
Further development of this form of tumor leads to its growth into the orbit, causing symptoms such as diplopia, exophthalmos, lateral and downward displacement of the eyeball, ophthalmoplegia on the affected side as a result of immobilization of the extraocular muscles by the tumor and damage to the corresponding oculomotor nerves, ophthalmodynia, optic neuritis, chemosis, and often orbital phlegmon.
"Mesostructure neoplasm", i.e. a tumor of the maxillary sinus "of its own origin". Such tumors in the latent period are practically not recognized due to the fact that they occur in this period under the sign of a banal inflammatory process, which is always secondary. In the developed stage, the tumor causes the same symptoms that were described above, but in this form, the predominant direction of exterritorialization is the facial area. The tumor spreads through the anterior wall in the direction of the canine fossa, zygomatic bone, and growing through the upper wall into the orbit in exceptional cases can cause a picture.
The tumor can also spread into the nasal cavity, causing its obstruction, into the ethmoid labyrinth through the ethmoid plate, affecting the olfactory nerves, and further towards the sphenoid sinus. The spread of the tumor along the posterior wall downwards and laterally causes its penetration into the retromaxillary region and into the CN.
Tumor growth through the posterior wall of the maxillary sinus leads to damage to the anatomical structures located in the CPN, in particular the pterygoid muscles (trismus), nerve structures of the pterygopalatine ganglion (Sluder syndrome). In foreign literature, neoplasms of the supra- and mesostructure are called "tumors of rhinologists", meaning that this form of malignant neoplasms of the paranasal sinuses is the responsibility of rhinosurgeons.
"Infrastructure neoplasms" or "dental type" tumors, or "dentist's upper jaw cancer". The starting point of tumor growth is the alveolar process of the upper jaw. These tumors are recognized much earlier than the above-described forms, since one of the first complaints about which a patient goes to a doctor (dentist) is unbearable toothache. Searches for a "sick" tooth (deep caries, pulpitis, periodontitis) usually do not yield any results, and the removal of a "suspicious tooth" that has been treated repeatedly does not relieve the pain, which continues to bother the patient with increasing intensity. Another symptom of this form of tumor is causeless loosening of teeth, often interpreted as periodontosis or periodontitis, but the removal of such teeth does not relieve the severe neuralgic pain. And only in this case does the attending physician suspect the presence of a tumor of the alveolar process of the upper jaw. As a rule, when removing teeth whose roots have direct contact with the lower wall of the maxillary sinus, in case of alveolar process cancer, perforations of this wall occur, through which the tumor tissue begins to prolapse in the coming days, which should already eliminate doubts about the diagnosis.
"Diffuse neoplasm"
This term, defining the last stage of development of a malignant tumor of the maxillary sinus, was introduced by the famous Romanian ENT oncologist V.Racoveanu (1964). By the gene stage the author means such a state of the tumor, in which it is impossible to determine the point of its origin, and the tumor itself has grown into all neighboring anatomical inversions, giving the facial area, in the words of the author, "the appearance of a monster". Such forms are considered to be absolutely operable cases.
The evolution of malignant tumors of the maxillary sinus is determined by the anatomopathological structure of the tumor. Thus, lymphosarcomas and so-called soft sarcomas are characterized by extremely rapid growth, devastating invasion of surrounding tissues, early metastasis to the cranial cavity, and their clinical manifestations - all the above-described dysfunctions of neighboring organs and fever. As a rule, they cause fatal complications before metastases to distant organs occur. Fibroblastic sarcomas, or chondro- and osteosarcomas (the so-called hard sarcomas), especially neoplasms of the infrastructure, are characterized by significantly slower development, do not ulcerate or disintegrate, due to which these tumors can reach enormous sizes. Unlike "soft" tumors, these tumors are resistant to radiation therapy and in some cases are amenable to surgical treatment.
Cancer of the maxilla, after going beyond the anatomical limits of the sinus, grows into the surrounding soft tissues, causing their decay and ulceration, and if the patient does not die by this time, then it metastasizes to the regional, pretracheal and cervical lymph nodes. At this stage, the prognosis is uncontested, the patient dies in 1-2 years.
Complications: “cancer” cachexia, meningitis, hemorrhage, aspiration and metastatic bronchopulmonary lesions.
Diagnosis of malignant tumors of the maxillary sinus
Diagnostics causes difficulties in the patent period. At subsequent stages, the presence of characteristic oncological and clinical signs in combination with X-ray or CT data does not cause difficulties. Differential diagnostics is of great importance, which must be carried out with the following nosological forms.
Banal sinusitis. The malignant tumor differs from the clinical manifestations of this disease by the strongest, incurable, neuralgic pains caused by damage to the first branch of the trigeminal nerve, often ophthalmodynia; foul-smelling grayish-bloody discharge, sometimes massive bleeding from the sinus. Radiographically, tumors are characterized by blurred contours of the maxillary sinus, significant shadowing of the sinus and other phenomena indicating the spread of the tumor to neighboring tissues.
A paradental cyst is characterized by slow evolution, absence of characteristic pain, invasion into surrounding tissues, and nasal discharge typical of a tumor.
Benign tumors have the same characteristics as paradental cysts.
Other diseases from which malignant tumors of the maxillary sinus should be distinguished include actinomycosis, dental epulis, gum cancer, and osteomyelitis.
Tumor location. Cancers of the suprastructure have the most severe prognosis due to difficulties and late diagnosis, and the lack of the possibility of radical removal. The latter causes their recurrence in the ethmoid bone and orbit, growth through the ethmoid plate into the anterior cranial fossa, and through the orbit into the retrobulbar region and middle cranial fossa. Tumors of the meso- and especially infrastructure in this regard have a less pessimistic prognosis, firstly, due to the possibility of earlier diagnosis, and secondly, due to the possibility of radical surgical removal of the tumor at the early stages of its development.
The prevalence of the tumor is one of the main prognostic criteria, since it is used to draw a conclusion about operability or inoperability in a given case.
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Treatment of malignant tumors of the maxillary sinus
Treatment of malignant tumors of the upper jaw is determined by the same criteria as the prognosis, i.e. if the prognosis is relatively favorable or at least gives some minimal hope for recovery or at least for prolonging life, then surgical treatment is performed, supplemented by radiation therapy.
In case of suprastructural tumors, a partial resection of the maxilla is performed, limited to the removal of its upper part, the lower and medial wall of the orbit, the entire ethmoid bone, preserving the ethmoid plate, as well as the nasal bone on the affected side, using the Moore, Otan or their combination approaches.
In case of mesostructural tumors, total resection of the maxilla is used. This literally mutilating and disfiguring operation is the only possible intervention that allows for complete removal of the maxillary tumor, but only if the tumor has not spread beyond this bone. The surgical method used is the Moore paralateronasal approach with an extension of the incision downwards with an envelopment of the ala of the nose and a medial incision of the upper lip in combination with the Otan approach. In this surgical intervention, the nasal bone on the affected side is resected, the upper end of the ascending branch of the maxilla is transected, the lower wall of the orbit is removed, the alveolar process is dissected along the posterior edge of the first molar, the hard palate is resected, the pterygomaxillary synostosis is dissected from behind, the soft tissues are separated, simultaneously performing hemostasis, and the tumor is removed as a whole block together with the maxilla.
Later, after the wound cavity has healed, various options for prosthetics of the upper jaw are used using removable dentures. Often, the first and second types of surgery are forced to be combined with enucleation of the eye affected by the tumor.
In case of infrastructural tumors, partial resection of the lower part of the upper jaw is used; the extent of surgical intervention is determined by the extent of the tumor.
The incision is made along the median plane of the upper lip, around the wing of the nose and into the nasolabial fold, then the mucous membrane is incised along the transitional fold under the lip. After this, by separating the soft tissues, the surgical field is freed for the removal of the tumor en bloc together with part of the upper jaw. For this purpose, the lateral wall of the upper jaw is resected in the upper part, the hard palate on the side of the tumor and the pterygomaxillary synostosis is separated. The resulting block is removed, after which final hemostasis is performed, the remaining soft tissues are subjected to diathermocoagulation and a bandage is applied. When applying a bandage in the case of using radiotherapy, radioactive elements are placed in the postoperative cavity.
Radiation therapy for malignant neoplasms of the ENT organs is one of the main methods of treatment. It is carried out using various types of ionizing radiation, in connection with which a distinction is made between X-ray therapy, gamma therapy, beta therapy, electron, neutron, proton, pimeson therapy, alpha therapy, and heavy ion therapy. Depending on the goal of treatment, which is determined by the prognosis criteria listed above, radiation therapy is divided into radical, the task of which includes achieving complete resorption and curing the patient, palliative, pursuing the goal of slowing down tumor growth and, if possible, prolonging the patient's life, and symptomatic, aimed at eliminating individual painful symptoms - pain, compression syndrome, etc. There is also anti-relapse radiation therapy, which is used after "radical" surgical removal of the tumor, when the appropriate radioactive nuclides are placed in the postoperative cavity. Radiation therapy is widely used in combination with surgery and chemotherapy.
Radical radiation therapy is indicated when the tumor has limited spread; it involves irradiation of the primary site and areas of regional metastasis. Depending on the tumor location and its radiosensitivity, the type of radiation therapy, the method of irradiation, and the SOD value (60-75 Gy) are selected.
Palliative radiation therapy is performed on patients with a widespread tumor process, in which, as a rule, it is impossible to achieve a complete and stable cure. In these cases, only partial tumor regression occurs, intoxication decreases, pain syndrome disappears, organ functions are restored to a certain extent, and the patient's life is extended. To achieve these goals, smaller SODs are used - 40-55 Gy. Sometimes, with high tumor radiosensitivity and a good response to radiation, it is possible to switch from a palliative program to radical tumor irradiation.
Symptomatic radiation therapy is used to eliminate the most severe and threatening symptoms of tumor disease that predominate in the clinical picture (spinal cord compression, esophageal lumen obstruction, pain syndrome, etc.). Radiation therapy, temporarily eliminating these manifestations of the disease, improves the patient's condition.
The therapeutic effect of ionizing radiation is based on damage to vital components of tumor cells, primarily DNA, as a result of which these cells lose their ability to divide and die. The surrounding undamaged connective tissue elements ensure the resorption of radiation-damaged tumor cells and the replacement of tumor tissue with scar tissue, so one of the main conditions for the successful implementation of radiation therapy is minimal damage to the tissues surrounding the tumor, which is achieved by careful dosing of radiation.
In clinical practice, the concept of radiotherapeutic interval is used, which characterizes the difference in radiosensitivity of the tumor and the normal tissue surrounding it. The wider this interval, the more favorable the radiation treatment. This interval can be expanded by selectively enhancing the radiation damage to the tumor or preferentially protecting the surrounding tissues with chemical radiomodifying agents - various chemical compounds (radioprotectors) introduced into the body before irradiation and reducing its radiosensitivity. Chemical radioprotectors include sulfur-containing compounds, such as cystamine, derivatives of indolylalkylamines, such as serotonin and mexamine. The damaging effect of ionizing radiation is significantly weakened in an atmosphere with reduced oxygen content, in connection with which radiation protection can be provided by inhaling gas mixtures containing only 9-10% oxygen immediately before irradiation and during irradiation.
The use of radiation therapy allows obtaining good results in many malignant neoplasms. Thus, the five-year survival rate of patients after radiation therapy for skin cancer stage I-II reaches 97%, for laryngeal cancer stage I-II - 85%, for lymphogranulomatosis stage I-II - 70%.
Radiation therapy after surgery for maxillary cancer is performed immediately after the operation by introducing cobalt pearls or radium tubes into the wound cavity, at least 20 in number, and the "containers" containing radioactive substances are placed along the perimeter of the cavity so that uniform irradiation of its walls is achieved, especially the expected site of tumor origin. At the same time, measures are taken to protect bone tissue, especially the cribriform plate, and the eyeball from ionizing radiation by placing small plates of lead rubber between them and the radiation source. The threads that fix the radioactive inserts are brought out through the common nasal passage and fixed with adhesive tape on the face.
According to various authors, favorable results with such combined treatment are observed in an average of 30% of cases. In other cases, relapses occur, mainly in the area of the ethmoid bone, orbit, base of the skull, pterygopalatine region, deep parts of the soft tissues of the face, etc.
Complications of radiotherapy include severe necrosis of bone tissue, damage to the orbital organs, secondary purulent complications with massive tumor decay, etc.
What is the prognosis for malignant tumors of the maxillary sinus?
Malignant tumors of the maxillary sinus have a varied prognosis. It plays an important role in determining the treatment tactics and assessing its expected outcome. A correctly constructed prognosis is based on the following criteria.
Morphological structure of the tumor: lymphoblastomas, embryonic sarcomas, observed most often in children, are characterized by extremely rapid development and in most cases end in the death of the patient. Other types of tumors with slower development, with early recognition, timely radical surgical and radiation treatment, can end in recovery.