Maxillary Antrum Carcinoma - A Wolf in Sheep’s Clothing

Abstract

Maxillary sinus squamous cell carcinoma is an invasive tumour that is usually diagnosed at an advanced stage, where the majority of patients have a very low prognosis and survival rate. We present a case of maxillary sinus carcinoma that affected the entire orbit, resulting in proptosis of the eye and nasal cavity. The patient was recommended for palliative treatment due to the high degree of its involvement and proximity to vital structures. It manifests with very mild to no signs, resulting in a late diagnosis. As a result, physicians must be mindful of maxillary sinus pathologies to make an early diagnosis. Paranasal sinuses are air-filled spaces located close to vital structures such as visual organs and the face. Maxillary, ethmoidal, frontal, and sphenoidal are the 4 paranasal sinuses that are named according to the bones in which they are situated. Nasal cavity and paranasal air sinus malignancies are uncommon. According to the literature, paranasal sinus malignancies account for less than 1 % of all human malignancies and 3 % of the total malignancies of the head and neck region. However, the maxillary sinus is the most frequent site of origin of primary malignant tumours amongst the paranasal sinuses.1 we need to raise general awareness among the oral stomatologists as Asian countries report a very high incidence of maxillary sinus carcinoma.2 The incidence of malignancies in maxillary sinus is high (60 % - 70 %) and less in the nasal cavity (12 % - 25 %), the Ethmoid (10 % - 15 %) and very rare in sphenoid / frontal sinuses (1 %).3 Further, not only the malignancies of maxillary sinuses are common, but they also incur the worst prognosis. Maxillary sinus carcinomas have very few symptoms and are similar to those of chronic paranasal sinusitis. They usually present themselves as locally advanced diseases. 4,5 Paranasal sinus malignancies are difficult to diagnose in the early stages and 90 % of cases are reported in T3 / T4 advanced stage.6 Environmental factors such as industrial pollutants, dust, smoke, and adhesives are the leading causes for the development of disease.7 Thus, sinonasal malignant tumours are rare and pose a challenge in diagnosis as well as treatment. Therefore, maxillofacial specialists should be aware of the signs and symptoms of this rarely occurring disease. This article presents a rare case of a 45-year-old female who reported to our OPD with a complaint of swelling in the right zygomatic area and proptosis of the right eye.