Introduction:
Diseases of the sinonasal region are also known as respiratory system diseases. Anatomically the nasal mucosa is made up of a thin layer of tissue that is pink in color. During the course of the day, these nasal mucosa undergo swelling during respiration. The swelling could be due to allergens like pollen grains and dust. These allergens can worsen the condition in patients already suffering from respiratory illnesses like allergic rhinitis.
What Are Benign Lesions of the Sinonasal Region?
Sinonasal disorders are very rare in occurrence. 50 percent of these tumors are benign, and 50 percent are malignant. It is more commonly seen among older men. They usually appear as localized lesions that are smooth and uniformly covered with a mucous membrane.
Causes:
Sinonasal lesions appear due to many factors like exposure to wood dust, which can trigger a cancerous condition called adenocarcinoma. People who work in the nickel refining industry are more likely to develop squamous cell carcinoma. It is also seen among the population who work in a big industrial area where there is more exposure to industrial fumes and leather tanning, and also among cigarette smokers and alcohol consumers.
What Are the Types of Sinuses Found Near the Nose?
The sinus present around the nasal cavity is called paranasal sinus. Blockage to these sinuses causes nasal obstruction, and the patient may experience headaches and eyeballs pushing downward. The four different types of paranasal sinuses are:
i) Frontal sinus.
ii) Sphenoid sinus.
iii) Ethmoid sinus.
iv) Maxillary sinus.
What Are the Kinds of Benign Tumors Seen in the Paranasal Sinus Region?
Both benign and malignant tumors can be seen in the nasal cavity and around the paranasal sinuses. The tumors can also be seen in head and neck sites. According to WHO, the various classifications of sinonasal tumors are
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Squamous Papilloma: These are also known as inverted papilloma of the nose or Schneiderian papilloma, transitional papilloma, or Ringertz tumor. It arises in the nasal region or sinuses, or urinary tract. The cell shows proliferation extending into underlining tissues. These inverted papillomas grow inwardly, lining the inner epithelium. The most common site of occurrence is the lateral wall of the nose. It appears unilaterally.
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Symptoms: Bleeding from the nose, nasal discharge, headache due to sinus involvement, lacrimation, or double vision due to orbital involvement.
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Clinical Features: A polypoidal irregular mass is seen, which bleeds on the touch. Deviation in the nasal septum is noted, and the nasal cavity is completely blocked.
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Diagnosis: Inverted papilloma of the nose can be examined by computed tomography (CT) and magnetic resonance imaging (MRI), where the extent and location of the lesion are appreciated. Histological studies show abnormal proliferation of cells under a microscope.
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Treatment of Choice: Surgical procedures like medial maxillectomy are done using endoscopy.
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Osteoma: These are tumors originating from the bony surface. Mostly they are benign tumors of the nose. It is treated surgically by excising endoscopically.
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Lobular Capillary Hemangioma: These are mostly seen among newborns after six months post-delivery. Capillary hemangiomas also occur due to trauma induced in the nose. Patient experiences bleeding from the left side of the nose with no pain and no difficulty in breathing. Medical management, like saline nasal drops and propranolol, is given to control bleeding. Surgical management is also done to remove the lesion.
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Fibrous Dysplasia: The enormous formation of bone around the nasal area causing nasal obstruction is known as fibrous dysplasia. Patients can be treated by removing slices of bone from all over the face. Such bone deposition reaching the eye can cause compression and obstruct the optical nerve.
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Cavernous Hemangioma: These are caused due to malformation of the arterio-venous system. The individual often presents with blood-filled blood vessels that are seen around the eyes, nose, brain, and lips. Cavernous malformation mostly occurs congenitally. Cavernous hemangioma starts occurring from 30 to 40 years of age. It can be treated using laser surgery and surgical resection. CCM2, KRIT1 (CCM1), and PDCD10 (CCM3) genes are responsible for a genetic mutation associated with cavernous hemangioma.
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Symptoms: Ear imbalance, seizures, weakness in legs and arms, vision problems, headaches, and attention and memory problems.
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Diagnosis: Magnetic resonance imaging (MRI) of the brain is done to evaluate the location and size of the lesion.
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Treatment: Medications like anticonvulsants are given to treat epilepsy. Symptomatic lesions are treated medically by giving drugs. Surgical therapy is done for serious cases where lesions are at the low-risk parts of the brain.
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Schwannoma: It is the tumor of Schwann cells. These Schwann cells are seen in the nerve cells that make myelin in the peripheral nervous system (PNS). Myelin speeds up the nerve impulses. In Schwannoma, the tumor starts developing in the Schwann cells and compressing them. Depending on the nerve impacted, the patient develops varying symptoms. For example, Schwannoma affects the cranial nerve eight (CN-VIII) or the vestibulocochlear nerve. It can cause hearing loss, ringing in the ears (tinnitus), fullness in the ear, and acoustic neuroma.
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Hematoma is caused by blood collecting at the base of the nose, known as the perichondrium and periosteum area. It can be caused due to nasal trauma, post-operatively, or bleeding disorder.
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Symptoms: Bilateral nasal obstruction, headache, and pressure over the nasal bridge.
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Treatment: Incision and drainage are done. Medical management with antibiotic therapy can be done.
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Ossifying Fibroma: These tumors originate from the mandible near the premolar and molar and are less common in the anterior area. It is mostly seen in children. Upon surgery, they showcase shelling property wherein they can be easily removed from the remaining part of the bone.
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Glioma: The word glioma means brain cells. These are congenital anomalies. Patients suffering from this disease complain of growth in their noses or feel a heaviness inside their noses. The connection between the brain and nose is limited within a thread-like medium. Patient experiences difficulty in breathing. It is treated by surgical excision.
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Pleomorphic adenoma: These are benign tumors of the salivary gland. Of which eight percent constitute the palate region. These palatal lesions can interfere with the nasal anatomy and cause nasal obstruction and difficulty swallowing.
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Juvenile Angiofibromas: These are tumors of vascular and fibrous tissue. It is a rare form of tumor and is commonly associated with adolescent males. This tumor is testosterone dependent. They originate from the posterior part of the nasal cavity. Severe bleeding of the tumor is noted upon excision.
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Symptoms: Nasal obstruction, bleeding, frog face deformity, hyponasal speech, hearing loss, and nasal discharge.
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Diagnosis: Computed tomography (CT) and magnetic resonance imaging (MRI) of the head is done to diagnose the condition.
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Treatment: Treatment involves surgery, radiotherapy, chemotherapy, and hormonal therapy.
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Nasal Polyps: These are masses growing inside the nose. These mass starts developing as a result of exposure to allergens. It usually starts with a bumpy projection but gradually increases in size as the stress caused by the allergen increases. As it starts enlarging in size, it takes up the form of a tumor. But these tumors are not all malignant. Nasal polyps are associated with asthma patients and patients having hypersensitivity reactions to Aspirin. The allergy to these two substances is collectively called an allergic triad.
Treatment: Avoid the allergens and surgically manage the patient.
Conclusion:
The nose is a highly sensitive area. Anything draining through the nasal passages can turn out to be harmful. Most of the epithelial lesions of the paranasal region treated surgically have a chance of recurrence. These masses inside the air-filled chambers cause much discomfort, primarily in the breathing mechanism.
