EN4.33 | Tumours of Nose, Nasopharynx and Paranasal Sinuses — Summary & Reflection

KEY TAKEAWAYS

Tumours of the nose, paranasal sinuses, and nasopharynx are characterised by late diagnosis. Malignant sinonasal tumours present with unilateral obstruction, blood-stained discharge, facial swelling, bone erosion on CT, and cranial nerve involvement. SCC is the commonest (maxillary sinus); ethmoid adenocarcinoma is occupationally associated with wood-dust (IARC Group 1). Inverted (Schneiderian) papilloma is the most important benign nasal tumour — locally aggressive, ~10% malignant transformation, requires complete excision. NPC is strongly EBV-associated (Types II and III); classic presentation is painless bilateral posterior cervical lymphadenopathy + unilateral conductive deafness + blood-stained postnasal discharge; arises in the fossa of Rosenmüller; Trotter's triad (deafness + palatal anaesthesia + immobile soft palate) indicates advanced disease. Investigation: nasal endoscopy + biopsy + contrast CT + MRI + EBV serology (NPC). Staging: Ohngren's line divides maxillary sinus into infrastructure (better prognosis) vs suprastructure (worse). Management: malignant sinonasal tumours — surgery (total maxillectomy) + post-op radiotherapy; NPC — concurrent cisplatin-CRT for Stage II–IVB (Intergroup 0099). Unilateral adult glue ear = nasopharyngoscopy to exclude NPC.

REFLECT

A 60-year-old male farmer is diagnosed with maxillary sinus squamous cell carcinoma requiring total maxillectomy. He will have a prosthetic obturator fitted for the palatal defect. He has not told his family the diagnosis and says he does not want them to know because 'they will be upset.' Reflect on the ethical and practical challenges of managing a patient who wishes to conceal a serious diagnosis from their family in an Indian cultural context where family involvement in medical decisions is expected. How do you balance the patient's right to confidentiality against the clinical need for a support system during intensive treatment and recovery?