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TUMOURS OF THE SINUSES
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.