TUMOURS OF THE SINUSES 91 sometimes loosening of the upper teeth on the affected side, and swelling of the cheek or hard palate. Later there is neuralgic pain referred to the ear, and involvement of the orbit with disturbance of vision. Extension to the base of the skull produces intense headache. The degree and constancy of the pain in the late case are the most distressing features. Three-quarters of all cases arise in the 40-60-year-old age groups. CLINICAL FEATURES. These depend upon the degree of extension of the tumour, when swelling of the cheek or hard palate may be found. Anterior rhinoscopy may show invasion of the nasal cavity by a friable, granular tumour mass which bleeds readily. The orbit must also be examined for evidence of spread. The cervical lymph nodes may be involved late in the disease. Radiography of the sinuses will show opacity of those involved with destruction of the bony walls (Fig. 44). Tomography of the maxillary sinus (Fig. 45) may give further information regarding this site and extension of the Fig. 44. Radiograph of carcinoma of the maxillary sinus with erosion of the medial wall. Fig. 45. Tomogram showing carcinoma of the maxillary sinus.