Surgery to remove a fibroma in the nose. Benign tumors of the nose

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Benign tumors of the nose and paranasal sinuses

Benign tumors of the nose and paranasal sinuses include papilloma, fibroma, adenoma, angioma, angiofibroma, chondroma, osteoma. The clinical features of these tumors are due to their localization in the nasal cavity, size, and growth pattern. Typical early signs of benign tumors are persistent unilateral obstruction of nasal breathing, hypo- or anosmia, bleeding, headache. IN late stages diseases occur deformations of the facial skeleton, displacement of the eyeballs, visual impairment. The diagnosis is established on the basis of the patient's complaints, rhinoscopy data, probing of the tumor, palpation, radiography.

The final diagnosis is verified by histological examination. The main method of treatment is surgical with the use of laser endonasal action, diathermocoagulation, ultrasound and cryodestruction.

Papilloma is the most common benign tumor of the nasal cavity. It has the appearance of warty growths on the mucous membrane, similar to cauliflower, localized on the eve of the nose on the lower wall, nasal septum or on the lower shell. The patient complains of feeling foreign body in the nose and difficulty in nasal breathing. The tumor grows slowly, often recurs after removal, has a tendency to malignancy, so its removal should be radical, and the wound surface should be subjected to cryotherapy or galvanocaustics.

Vascular tumors - hemangioma, lymphangioma - most often develop in the cartilaginous section of the nasal septum, inferior turbinates, and the nasal cavity vault. They have a bumpy surface, reddish-bluish color, grow slowly, periodically bleed. Constantly growing, the tumor can fill the entire nasal cavity and grow into nearby organs: the ethmoid labyrinth, maxillary sinus, orbit. Surgical treatment. In the case of a large tumor, carotid angiography is performed to identify its boundaries. To prevent massive blood loss before removing the tumor, they resort to ligation of the external carotid arteries. In the case of non-radical removal of the tumor, relapses are possible.

One of the most common hemangiomas is a bleeding polyp (angiofibroma). It is a highly vascularized fibromatous formation that develops in the cartilaginous part of the nasal septum, has a wide rounded base with a smooth or lobulated surface of red color. Most often occurs in women during pregnancy or lactation. Patients mainly complain of unilateral obstruction of nasal breathing and often recurring nosebleeds.

Treatment consists in removing the polyp with nearby tissues of the nasal septum (Fig. 155).

Rice. 155. Removal of a bleeding polyp of the nasal septum

Fibroma is localized in the vestibule of the nose or in the region of the external nose. Diagnosis is not difficult. Surgical treatment.

Adenoma develops most often in the cartilaginous part of the nasal septum in the region of the tubercle (tuberculum septi nasi), that is, in the place richest in glandular tissue. This tumor is characterized by slow growth, has no tendency to infiltration. During rhinoscopy, it is defined as a mobile formation of pink color with a smooth or somewhat bumpy surface.

Chondroma is rare, mostly in adolescence. It develops on the nasal septum or the walls of the paranasal sinuses, has a wide base. The tumor is dense to the touch, covered with a mucous membrane.

Osteoma most often develops in the frontal sinuses. It is determined, as a rule, by chance on radiographs of the paranasal sinuses. In most cases, it has a wide base, grows slowly. At first, the tumor develops asymptomatically, but later, depending on its localization, different clinical symptoms occur.

Growing, the tumor can spread into the cranial cavity, nose, orbit, and lead to deformation of the facial skeleton. It can cause headaches, decreased vision and smell. Surgical treatment is subjected only to an osteoma of medium and large sizes.

Malignant tumors of the nose and paranasal sinuses

Malignant tumors of the nose and paranasal sinuses - cancer, sarcoma, melanoma, neuroesthesioblastoma (cancer from the cells of the olfactory epithelium), as a rule, are primary, occur mainly in middle-aged and elderly men. These tumors are isolated only at the initial stage of development, then they grow relatively quickly into adjacent organs and tissues: the orbit, the cranial cavity, the pterygopalatine fossa, the oral and nasal cavities, and the adjacent paranasal sinuses.

Metastasis occurs late, first to deeply located pharyngeal and submandibular lymph nodes, inaccessible for clinical examination, and then to superficially located cervical lymph nodes, which are easily determined by palpation. Most often (65-75%), the maxillary sinus is affected, less often (15-25%) - cells of the ethmoid labyrinth, nasal cavity (5-10%), frontal and sphenoid sinuses (1-2%).

According to the clinical and anatomical classification, the spread of the tumor of the nose goes through four stages: I - the tumor is limited to one anatomical region without bone destruction, regional metastases are not detected; Stage II: a) two anatomical sections are affected with focal bone destruction, the tumor does not extend beyond the nasal cavity, regional metastases are not detected; b) there is a single easily displaced metastasis on the side of the lesion; Stage III: a) the tumor extends beyond the nasal cavity, regional metastases are not detected; b) there is a limitedly displaceable one-sided or many displaceable metastases; IV stage: a) there is germination in the nasal part of the pharynx, the base of the skull or the skin of the face with a large bone destruction, regional and distant metastases are not determined; b) tumor of the nasal cavity of any degree with fixed regional or distant metastases.

At the initial stages of the development of a tumor of the nasal cavity, patients complain of a constant unilateral increasing difficulty in nasal breathing, mucous discharge from the nose, which later becomes bloody and fetid. Then there are nosebleeds, stuffy ears, otalgia. During rhinoscopy, the tumor is determined as a bumpy pink formation.

Often it is polypoid, which causes an erroneous diagnosis of nasal polyposis. Removal of such polyps is accompanied by significant bleeding, which should alert the surgeon. Later, the tumor grows through the ethmoid labyrinth into the orbit, forehead, maxillary sinuses, skull base with the development of the corresponding symptoms.

The course of malignant neoplasms of the maxillary sinus is asymptomatic for a long time, and only in the case of spread to nearby tissues do clinical signs of secondary sinuitis appear.

Clinical manifestations of the tumor are determined by the location and direction of its growth (Fig. 156). With the development of a tumor on the lower wall of the maxillary sinus, patients complain of pain in the teeth and their pathological loosening, deformation of the hard palate. Tumor growth on the medial wall of the sinus leads to lacrimation, swelling near the medial corner of the eye, congestion of the corresponding half of the nose and purulent bloody discharge from it.

Rice. 156. Scheme of the distribution of malignant tumors of the maxillary sinus of different localization

The defeat of the posterior and outer walls of the maxillary sinus is accompanied by neuralgia of the cranial nerve. If the tumor grows into the orbit, there is limited mobility of the eyeball, its displacement, exophthalmos. According to the degree of spread of the tumor and metastases, four stages are distinguished, as with tumors of the nasal cavity.

The primary lesion of a malignant tumor of the frontal and sphenoid sinuses is rare. In the case of neoplasms of the frontal sinuses, a headache is noted in the affected area. With the growth of the tumor, deformation of the face occurs. If the tumor grows into the orbit, there is a displacement of the eyeball downward and outward, swelling of the upper eyelid. For tumors of the sphenoid sinus, painful manifestations are characteristic. If the tumor grows into the cranial cavity, signs of damage to the cranial nerves (II, III, IV, V, VI) are observed, which entails decreased vision, diplopia, neuralgic pain in the supraorbital region, absence of a corneal reflex, etc.

Diagnosis of malignant neoplasms of the nasal cavity and paranasal sinuses in the early stages presents significant difficulties. Quite often tumors of this localization are shown by symptoms of rhinitis and sinuitis. In addition to endoscopic methods, puncture and probing of the sinuses, conventional and contrast radiography in different projections, tomography, CT, MRI, ultrasound, cytological and histological examinations are used in diagnostics.

In the early stages, the treatment of malignant neoplasms of the nasal cavity and paranasal sinuses is usually surgical. With common tumor processes, combined (radiation and surgical) treatment is effective. The method of irradiation is used in two stages: after the end of half of the course of radiation treatment, its results are evaluated.

If the tumor is reduced by more than half, irradiation is continued. If radiation does not work, the tumor is radically removed. Access and volume of surgical intervention are determined by the localization of the lesion and the predominant direction of growth. For wide excision of neoplasms of the nasal cavity and cells of the ethmoid labyrinth, Moore's approach is used (Fig. 157), in the case of tumors of the maxillary sinuses - according to Denker (Fig. 158), frontal sinuses - according to Praising (Fig. 159).

Rice. 157. Bone hole during Moore operation

Rice. 158. Bone hole during Denker operation

Rice. 159. Bone hole during the Pricing operation

If the tissues of the orbit or the hard palate and the alveolar process of the upper jaw are involved in the tumor process, the possibility of a wide surgical intervention with resection of the upper jaw and exenteration of the orbit is allowed. As a rule, with such volumetric surgical interventions, bilateral ligation of the external carotid arteries is preliminarily performed. Rough cosmetic defects of the face are eliminated with the help of plastic surgery, use of individual prostheses.

Chemotherapy is most often used along with radiation and surgery. Chemotherapy drugs are used in different combinations, doses, modes of administration (regionally - intra-arterially or systemically - intravenously or orally).

The choice of an adequate method for the treatment of malignant tumors of the nasal cavity and paranasal sinuses is carried out depending on the location and spread of the lesion, the morphological structure of the tumor, and the general condition of the patient.

DI. Zabolotny, Yu.V. Mitin, S.B. Bezshapochny, Yu.V. Deeva

In the nasal cavity and its paranasal sinuses, as in other organs human body the formation of benign and malignant tumors is possible. The alarming symptoms that we will learn about in this article require an immediate visit to an otolaryngologist, due to an unfavorable prognosis for advanced nasal cavity cancer. Benign tumors of the nasal cavity and paranasal sinuses have a relatively favorable prognosis, but also require timely treatment.

Benign tumors of the nasal cavity
Name of the tumor	Description	Symptoms
nasal polyps	Nasal polyps are tumor formations very conditionally. The cause of polyps is a chronic inflammatory process in the nose or paranasal sinuses. The growth of the nasal mucosa may be associated with an allergic mood of the body. The disease has no connection with age and is recorded in the same proportion in both men and women.	Difficulty in nasal breathing, nasal congestion on one side. When inflammation is attached - mucous purulent discharge from the nose, persistent headaches.
Osteoma	Tumor bone tissue. It rarely occurs primarily in the nasal cavity. Usually, the osteoma begins to develop in the frontal or maxillary sinuses, and then, as it grows and enlarges, it penetrates into the nasal cavity. Osteoma of the nasal cavity is a disease more typical for young patients. Inside the tumor has a spongy structure, and outside it is covered with dense bone tissue.	Difficulty in nasal breathing. The appearance of mucopurulent discharge from the nose. Pain in the face, trigeminal neuralgia. Frequent bleeding from the nose. Lachrymation. Recurrent sinusitis. Exophthalmos.
Vascular tumors (hemangiomas, angiofibromas, lymphangiomas).	A favorite place for the localization of vascular tumors is the nasal septum (cartilaginous section). Vascular tumors have a characteristic appearance (tuberosity) and a cyanotic color. Vascular tumors have the property of bleeding. When removing large tumors, there is a danger of massive bleeding, so the treatment of such formations is a responsible task for a surgeon. Removal of small tumors is not a major problem. Small vascular tumors are removed with a polyp loop or cauterized.	Nosebleeds. Difficult nasal breathing.

According to the International Classification, benign tumors are divided into several groups: epithelial benign tumors, soft tissue formations, cartilage and bone tumors, mixed tumors, tumor-like formations. Unlike malignant diseases of the nasal cavity and paranasal sinuses, benign tumors are very common and occupy a significant place among other pathologies of the ear, throat and nose.

In the initial stages of the development of a benign tumor in the nasal cavity, the symptoms of the disease appear so poorly that patients do not pay attention to them. A benign tumor of the nasal cavity at an early stage can be disguised as one of the common ENT pathologies, therefore, the patient can receive polyclinic treatment for a long time, which does not bring any effect. In order to avoid a diagnostic error and provide timely assistance to the patient, if a serious illness is suspected, the general practitioner must prescribe a comprehensive examination.

• Refer for a consultation with specialists (ENT doctor, maxillofacial surgeon, radiologist, oncologist, neurosurgeon, etc.)
• Schedule a complete blood test
• Refer for magnetic resonance imaging and positron emission tomography with isotope scanning
• Take a biopsy. To confirm the diagnosis, it is necessary to take a biopsy from the pathological focus.

Benign connective tissue tumors

The most common benign soft tissue tumor of the nose is hemangioma. This disease occurs equally often in both men and women, and there are no differences in terms of age. Sometimes nasal hemangiomas occur in women during pregnancy. Most often, the hemangioma is located on the anterior part of the nasal septum, where the border of its cartilaginous and bone parts passes.

A hemangioma is a polyp richly supplied with blood vessels and consisting of connective tissue. The basis of the occurrence of hemangioma is the inflammatory process, so its assignment to tumors is very conditional. Hemangioma manifests itself as frequent bleeding from the nose, nasal congestion. Education is so characteristic appearance that the diagnosis can be made without biopsy data. If there is doubt about the diagnosis, a biopsy is mandatory.

Angioma has much in common with hemangioma. Education is characterized by:

• slow growth
• periodic bleeding
• the possibility of germination in the orbit, maxillary sinus and ethmoid labyrinth.

Cysts and polyps that occur in the nose are tumor-like lesions.

Angioma, like hemangioma, is a vascular tumor. It has a characteristic appearance and is a reddish-bluish formation of a rounded shape with a bumpy surface.

For very large angioma, an angiography of the carotid arteries is recommended to determine the boundaries of the formation. Although surgical treatment carries the risk of complications (major bleeding), it is the main treatment for vascular tumors. If a radical operation to remove the angioma is not possible, then relapses are likely to occur in the future.

Benign tumors of bone and cartilage

Chondroma is a benign tumor that develops from hyaline cartilage. Most often, the chondroma is localized in the ethmoid sinus, much less often in the region of the wings of the nose and the anterior part of the nasal septum. Chondroma is a disease that is more common in younger patients. The main symptom of chondroma is slow and expansive growth (which is typical for benign tumors - as it grows, the formation compresses the surrounding structures and tissues). However, the chondroma also has signs of a malignant neoplasm - it has the ability to grow into the orbit and the anterior cranial fossa. At the beginning of the disease, the symptoms are rather poor, as the chondroma increases, nasal congestion, respiratory failure through the nose, headache, pain in the bridge of the nose appear.

Fibroma of the nose- This is a rare disease that is usually localized in the region of the external nose or in its vestibule. Fibromas grow on a wide base or on a narrow stalk. Despite the fact that fibroma is considered a benign tumor, it can have a rather aggressive course - grow quickly to a large size, grow into the orbit and paranasal sinuses. Sometimes fibroma proceeds absolutely benignly - in medical literature cases are described when fibroma progressed within 12 years, but did not grow into other departments.

Clinical symptoms of the disease appear as the fibroma reaches a significant size. While the fibroma is localized within the nasal cavity, the patient may be disturbed by nasal congestion and heavy nosebleeds. When sprouting into the orbit and paranasal sinuses, lacrimation, visual impairment joins.

Osteoma rather rarely formed in the nasal cavity and its paranasal sinuses. The tumor has a benign course and is characterized by slow growth - osteoma can develop over several years. The prognosis for this disease is relatively favorable, although it must be borne in mind that this formation has the ability to grow into the cranial cavity and orbit, although this is extremely rare. Timely diagnosis and treatment significantly increase the patient's chances of a complete cure for osteoma. Osteomas that involve the sphenoid sinus have a particularly poor prognosis.

Benign tumors with a typical or transitional cell structure

Papilloma with a typical structure refers to benign tumors of the skin. It is a papillary growth of the flat epithelial tissue. Papilloma may be a single formation or growth, consisting of multiple formations (bush). Papilloma can occur in soft and hard form. A papilloma with a typical structure can be removed with a laser or cryosurgery.

Papilloma with transitional cell structure is a completely independent disease, different from papilloma with a typical structure. Otherwise, it is called a true papilloma. Most often, such papillomas grow on a broad base. Such papillomas have the ability to invasive growth and germination into neighboring tissues and anatomical structures.

Nasal papillomas are subject to removal if the patient feels discomfort, as well as with recurring nosebleeds. It is also worth considering the risk of papilloma degeneration into cancer. The approach to the treatment of papilloma should be complex - after a surgical operation to remove the formation, it is necessary to carry out cryotherapy on the tumor bed. Outwardly, papilloma with a transitional cell structure resembles a cauliflower.

Symptoms of papilloma:

• Nosebleeds
• Nasal congestion
• Isolation of the ichor
• lacrimation

Transitional cell papilloma is able to spread to the paranasal sinus and beyond. In this case, facial deformation and displacement of the eyeball are observed. Since there is always a possibility of malignancy of the papilloma, a biopsy is mandatory before starting treatment.

Inna Bereznikova

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The nose contains tissues with different embryogenesis. They interact with each other in a complex manner, as a result of which, having a complex structure. The most common occurrence is the appearance of a craniocerebral hernia inside the nose, in childhood.

Reasons for the formation of a tumor

It is impossible to say exactly where neoplasms in the nose come from. As with other oncological diseases, it is not possible to determine the cause.

One thing can be said, people who smoke or work in the field related to wood processing, the furniture industry, are exposed to dangerous wood dust every day. This contributes to the occurrence of terrible ailments, including tumors of the maxillary region.

Frequent consumption of alcoholic beverages, contaminated environment All of these are major risk factors.

Factors that increase the risk of neoplasms in the nose:

• exposure to some of the chemicals;
• HPV - human papillomavirus;
• diagnosis of oncological eye disease;
• personal, hereditary predisposition;
• performing radiation therapy.

What happens in the body with the formation of a tumor?

A craniocerebral hernia appears due to the fact that part of the brain, its membranes protrude through a defect in the base of the cranial fossa in front. This hernia may continue to communicate with the cranial cavity (physicians receive cerebrospinal fluid by puncture). The hernia in almost all cases is covered by the epidermis. It is soft on palpation and is often combined with other malformations of maturation.

Hernias that are located in the region of the root of the nose are defined as external or anterior. They come out through imperfections formed as a result of underdeveloped bones of the external nose or their divergence.

Hernias located inside the nasal sinuses exit through damage to the horizontal plate of the ethmoid bone into the nasal cavity. Very often they are mistaken for a polyp. Removal of this type of hernia can provoke the development of recurrent meningitis.

The size of the hernia can increase with strong screaming, coughing and crying.

In the future, histological studies in the hernial sac may reveal the meninges or its substance.

Tumors in the sinuses are of the following types:

1. is a formation that belongs to dysembryoplastic. Its development comes from undifferentiated embryonic primordia preserved after birth;
2. angioma is most often formed near the nasal sinuses (in the mesh, frontal, maxillary). Sinusitis trauma can contribute to the origin of this formation;
3. Endochondroma (chondroma of delicate tissues) arises from dystoic cartilaginous embryos. The localization site, as a rule, is the area where the cartilage is absent. It belongs to the group of borderline tumors, and is capable of frequent relapses;
4. chordoma is a rare disease related to dysontogenetic tumors. The origin occurs due to the remnants of the dorsal string. It enters the nasopharynx and nasal cavity from the cranial cavity. In addition, it can also originate in the maxillary region from the very beginning;
5. papillomas are similar to papillomas in other areas. They develop in the perspective of a long inflammatory process from the squamous stratified epithelium of the skin in the vestibule of the nose. They chose the vestibule of the nose and on the plane of fibrous polyps as the place of localization. They are characterized by an uneven surface, located on a wide base, or have a distinctive papillary appearance on a narrow stem. In this case, they can be hard or softer, single or multiple;
6. schwannoma (they are also neurilemmoma and neurofibroma) is formed from the Schwann sheath of the nerve trunk. Between them there is a connective tissue capsule;

1. myxoma is characterized by mesenchymal origin. When a soft tissue tumor is in oncomorphology;
2. osteoma is formed mainly in young people, it is characterized by slow development. Chondroma occurs mainly in adolescence;
3. most often affects boys adolescence, hence the name juvenile.

Classification of tumors of the nasal sinuses

Tumors of the nose are classified into the following types:

• benign neoplasms: highly differentiated, non-malignant formations of the nasal sinuses;
• craniosinusonasal neoplasms. Grow into the sinuses of the nose, come from the cranial cavity;
• malignant neoplasms.

Tumors of the nose are characterized by various degrees of spread and damage:

The clinical picture of the origin of all benign processes in the nasal cavity at first looks the same. The first signs of the disease do not have specific features.

Children begin to be disturbed by unilateral difficulty or complete absence of breathing through the nose. In some cases, there may be bilateral absence of breathing. In addition, there is a purulent runny nose. With vascular tumors, spontaneous bleeding from the nose can be observed.

Difficulty breathing through the nose (due to the growth of the cyst).

Later, a headache joins, with intensive growth, displacement and bone destruction of the walls of the nasal sinuses occur.

If the tumor begins to grow into the orbit, then some signs will be noted on the zygomatic region:

• double vision appears;
• tearing;
• forward displacement of the eyeball;
• injection of scleral vessels.

When the tumor spreads into the oropharynx, there is impaired breathing.

Pain sensations are not typical, but may occur in case of damage to the orbit, the alveolar process of the upper jaw.

Symptoms

In adults, a runny nose with purulent, unpleasant discharge from the nasal cavity develops quite quickly, and frequent bleeding appears. A little later, headaches and neurological ailments begin to torment. If the tumor began to germinate in the maxillary region, in neighboring tissues, a process such as swelling of the bones begins. There is a deformation of nearby organs. The amount of blood in the body is sharply reduced. The person becomes irritable, is in constant nervous tension.

Sarcoma is characterized by rapid germination deep into the nasal cavity, which leads to deformation of the facial bones. This phenomenon is quite common in childhood. Since the bones have not yet fully formed in children, their germination occurs very quickly. At first, the whole process is not very noticeable, but it will appear very soon toothache, breathing becomes difficult, frequent bleeding, despite the fact that no changes will be detected on the nasal mucosa.

As soon as the tumor germinates in the maxillary region, the displacement and deformation of the eyeball begins, the sky also swells and shifts. At the first appearance of symptoms in children, it is urgent to undergo physiotherapy. With the help of this study, it will be possible to establish how the tumor progresses.

A benign tumor has big difference from malignancy. The location of a benign neoplasm is determined by one place, while the spread of a malignant tumor goes beyond the boundaries of one tissue.

To diagnose the disease at the initial stage, it is required to undergo special medical studies in case of unexplained bleeding and difficulty breathing through the nose.

The further course of the disease can manifest itself in different ways.

Diagnostics

Diagnosis of neoplasms in the nasal cavity occurs using different methods:

1. radiography. This type research makes it possible to qualify the localization of the tumor and its spread. In the course of its development, the neoplasm occupies the entire area of ​​​​the nasal passage, thereby destroying the bone walls. At this stage, the radiograph reveals a diffuse darkening in the nose with damage to the bony walls;

radiograph

1. contrast radiography. The study highlights a more thorough understanding of the nature of the disease. Allows you to identify irregularities in the contour;
2. computed tomography and MRI. This is the most important examination in determining the need for surgical intervention, how to act and in what volumes;
3. Computed tomography makes it clear how large the density of the tumor is, how far inward it spreads. The examination gives a complete picture of the neoplasm using a three-dimensional picture. Pockets, ridges and depressions become visible, any disease of the nose and maxillary sinus is verified;
4. MRI of the maxillary sinus significantly increases the possibilities of radiation diagnosis. It is characterized by significant superiority in the examination of soft tissue structures;
5. fibroendoscopy. This study is carried out in case of contradictions about the nature of the tumor. It gives a more accurate idea of ​​the disease, its spread, as well as the state of the tissues around;
6. cytological examination;
7. biopsy of surgical material. Allows you to establish an accurate diagnosis.

Treatment of tumors in the nose

When neoplasms are detected in the nasal cavity and maxillary sinus, treatment is carried out differentially. It all depends on the nature of the tumor, its type, volume and associated changes.

Removal of the maxillary papilloma is carried out with a nasal loop, followed by cryo, laser destruction.

Teratoma is eliminated with an electrocautery and a raspator, in rare cases with a polyp loop.

The treatment of congenital hemangiomas is reduced to the fact that sclerosing agents are introduced into the tumor, surgical laser destruction based on large-scale corticosteroid therapy.

Removal of maxillary craniocerebral hernia is performed at the same time, with plastic closure of bone damage.

Surgery for maxillary sinus cyst

Benign neoplasms in children are eliminated in a functionally gentle way. If possible, operations are performed without ligation of the arteries, taking into account the characteristic features of the nasal blood supply.

How to treat a swelling of the wrist?

A group of neoplasms of the nasal cavity of different tissue origin, characterized by the absence of tumor ulceration and its metastasis. Benign tumors of the nasal cavity are manifested by difficulty in nasal breathing, impaired odor perception, foreign body sensation in the nose, headache, mucopurulent discharge from the nose. The main data in the diagnosis of benign tumors of the nasal cavity are the data of rhinoscopy and histological examination. The prevalence of the tumor process is assessed by radiography of the nasal sinuses, pharyngoscopy, CT of the skull, CT and MRI of the brain, and ophthalmological examination. Treatment of benign tumors of the nasal cavity is their excision, electrocoagulation, laser destruction, sclerosis.

General information

Among the benign tumors of the nasal cavity, papilloma, angioma, bleeding polyp, chondroma, osteoma, fibroma, adenoma, chordoma, myxoma, lipomaotolaryngology are observed in patients of any age. In children, tumors of a congenital nature predominate, associated with impaired differentiation of the rudiments of the embryo and the occurrence of anomalies in the process of intrauterine development. These include angiomas, dermoid cysts, ganglioneuromas, chordomas.

Causes

With regard to congenital benign tumors of the nasal cavity, the causative factors are various exogenous and endogenous teratogenic effects on a woman during pregnancy. Trigger factors for the appearance of benign tumors of the nasal cavity in adults are long-term adverse effects on the nasal mucosa. They may be associated with the presence of a chronic disease of the nasopharynx of infectious (chronic rhinitis, sinusitis, sinusitis, rhinopharyngitis, adenoids) or allergic (allergic rhinitis, hay fever) genesis; dust or smoke in the work area; inhalation of various irritants (for example, from workers in the chemical or pharmaceutical industry); frequent injury to the nose and its mucous membrane.

Symptoms

Benign tumors of the nasal cavity at the beginning of their development proceed without any clinical manifestations. Symptoms occur when the tumor reaches a significant size and begins to interfere with the normal flow of air into the nasopharynx. In this case, the patient experiences difficulty in nasal breathing, which is usually the reason for his appeal to the otolaryngologist. There is also a decrease in the susceptibility of odors (hyposmia), a sensation of a foreign body in the nasal cavity and nosebleeds, especially intense in the vascular nature of the tumor.

As a result of impaired ventilation of the nasal cavity, a secondary infection often occurs with the development of rhinitis or rhinosinusitis. In such cases, patients with benign tumors of the nasal cavity complain of mucous or mucopurulent discharge from the nose, headache and pain in the area of ​​the inflamed sinus.

Some benign tumors of the nasal cavity (angioma, chondroma, osteoma) have infiltrative growth and can spread to the paranasal sinuses, pharynx, orbital cavity, and brain. The growth of such tumors with damage to the pharynx has a clinical picture similar to benign tumors of the pharynx and manifests itself as a violation of swallowing (dysphagia) and breathing. The germination of the tumor into the orbit is characterized by exophthalmos, diplopia, narrowing of the visual fields, limited mobility of the eyeball, and decreased visual acuity. The spread of a benign tumor of the nasal cavity to the structures of the brain can be manifested by increased headache, unilateral smoothing of the nasolabial fold, epileptic seizures, disorders of the cranial nerves and other symptoms.

Osteomas and chondromas often grow into the bone structures that form the nasal cavity and the walls of the paranasal sinuses, causing their destruction. As a result, in the clinical picture of these benign tumors of the nasal cavity, there is a curvature of the nasal septum and various facial deformities.

Diagnostics

Benign tumors of the nasal cavity are diagnosed by an otolaryngologist. Rhinoscopy is performed, which allows the doctor to examine the formation, differentiate it from scleroma and foreign body, and determine by appearance what type of tumor it belongs to. Asymptomatic benign tumors of the nasal cavity of the initial stage can be detected by chance during rhinoscopy for another disease. Diagnostically complex formations of the nasal cavity are an indication for consultation with an oncologist and an endoscopic biopsy.

Violation of smell in benign tumors of the nasal cavity is detected during olfactometry. In order to study the degree of tumor growth into structures adjacent to the nasal cavity, radiography of the paranasal sinuses, radiography and CT of the skull, pharyngoscopy, CT and MRI of the brain are performed; consultation with an ophthalmologist with visual acuity testing, exophthalmometry, visual field determination and ophthalmoscopy (examination of the fundus). To identify pathogenic microflora in the presence of an infectious process, a swab is taken from the throat and nasal cavity.

Treatment of benign tumors of the nasal cavity

Due to violation of normal respiratory function, the risk of malignancy and growth of benign tumors of the nasal cavity are an indication for surgical treatment. Restrictions on surgical intervention may be elderly age patient and the presence of chronic decompensated diseases (heart failure, ischemic heart disease, severe hypertension, respiratory failure, bronchial asthma, diabetes mellitus, renal failure, liver cirrhosis, etc.).

Forecast

Most benign tumors of the nasal cavity are characterized by slow non-invasive growth and are not prone to malignancy, which makes them prognostically favorable for the complete recovery of the patient, especially with timely treatment. Papillomas and bleeding nasal polyp are often complicated by postoperative relapses. The most unfavorable of the benign tumors of the nasal cavity are osteomas and chondromas, which, as they grow, cause the destruction of surrounding tissues and are prone to malignancy with the development of osteosarcoma and chondrosarcoma. After removal of osteomas and chondromas, extensive tissue defects often remain, synechia may form in the nasal cavity, and choanal atresia may develop. These factors lead to a persistent violation of nasal breathing and a complete loss of smell.

According to current WHO information, nasal tumors occur in one of two hundred cases of neoplasms in otolaryngology. At the same time, the most common disease is squamous cell carcinoma of the nasal cavity - it is diagnosed in eight out of ten patients with suspected benign or malignant neoplasms. All oncological diseases of this organ are divided into internal tumors of the nose and paranasal sinuses, that is, abdominal diseases and those that affect the osteochondral pyramid and the outer integument.

Main characteristic

Symptoms of oncological diseases of the nasal cavity depend on the type of tumor, its exact location and stage. Malignant tumors of the nose go through four main stages of development:

• latent (hidden, asymptomatic);
• period of intranasal localization;
• the stage of tumor exit beyond the boundaries of the nasal cavity and the germination of cancer in neighboring organs;
• the period of metastasis and damage to nearby lymph nodes.

In some cases, metastases can appear much earlier, starting from the second stage. With the appearance of distant cancerous foci, the patient's prognosis is unfavorable, the chances of a five-year survival are minimal. The most dangerous tumors of the nose are mesenchymal neoplasms (sarcomas), which differ depending on the tissues from which they arise. So, for example, fibrosarcoma develops from fibrous tissue, and chondrosarcoma affects Both types of cancer are characterized by early metastasis, even at small sizes.

It is extremely rare for patients to be diagnosed with cancer of a mesenchymal nature, which are considered to be gliosarcomas of the nasal wings and disembryomas that occur at the base of the septum. Mesenchymal tumors are characterized by dense infiltrative growth, absence of pain, and visually noticeable mucosal lesions.

Nose pyramid formations

Cancers of this part of the face can arise from the squamous epithelium, which is the outer skin, or from the mesenchymal tissues that make up the framework of the nasal pyramid. A malignant formation can form from bone and connective tissue, including cartilage. are diagnosed, as a rule, in adult patients, mesenchymal ones occur in patients of all age groups.

Epithelial tumors

Depending on the structure of the formation, there are several types of cancer. Cutaneous epitheliomas that arise from the basal layer are collectively referred to as basaliomas. These are malignant tumors of the nose, which most often appear in elderly patients due to the malignancy of senile keratosis. Basaliomas appear various symptoms, reminiscent of the flow of a disease such as squamous cell skin cancer. Epitheliomas at an early stage are successfully treated with radiation and chemicals. In appearance, basaliomas resemble keratinized spherical formations, which are characterized by rapid growth and the appearance of metastases. In addition, epitheliomas often recur after a course of radiotherapy.

In addition to basalioma, in the classification of epithelial tumors there is a cylindrom. It arises from the columnar epithelium, which is located at the edges of the nostrils. A nevoepithelioma may appear on the nose, a feature of which is the development of a pigment spot or nevus. last view has a separate name - melanoblastoma. So the neoplasm of the skin of the nose is first manifested by changes in the color of the nevus, its bleeding and ulceration at the slightest damage. Outwardly, the primary focus of a skin tumor resembles a papilloma or a bleeding ulcer, a pimple.

Neocarcinomas are neuroepithelial in nature and occur in the area of ​​the nose responsible for the function of smell. Symptoms are manifested by irritation of the mucous membrane from the back side but can sometimes occur on the septum.

Sarcomas of the nasal pyramid

This type of malignant tumor develops in the nasal cavity and is determined depending on the type of affected tissues. Pathologies of the inner part of the nose are divided into fibrosarcomas, chondrosarcomas and osteosarcomas.

Fibrosarcomas are pathological cancerous formations formed by fibroblasts and huge spindle cells, which explains the characteristic appearance of such tumors. The second name of the disease is fuzzcellular sarcoma. It is possible to recognize the disease in time only in isolated cases, the pathology has a progressive malignant course, rapidly increases in size and is capable of early metastasis, spreading through the body by the hematogenous route.

Chondrosarcomas are neoplasms cartilage tissue, which rarely affect the tissues of the nose. Just like the previous type of cancer, this tumor is located inside the nose, has a similar malignancy, and metastasizes in the early stages.

Osteosarcomas are cancers that develop with a high proliferative rate. Unlike previous cancers, osteosarcomas are composed of osteoblasts and mesenchymal cells. The tumor may have a fibrous, cartilaginous, or bony appearance, most often metastasizing to the lungs and brain. The survival prognosis for patients with this type of cancer is unfavorable.

Another dangerous view cancerous tumors of the nose are lymphosarcomas, which are distinguished by the proliferation of lymphoid tissue. Lymphorsarcoma is located on the middle and septum. Each experienced oncologist is able to recognize any of these types of cancer by outward signs and features of the clinical course, and the diagnosis is confirmed by histological examination of the removed biopsy.

Cancer of the nasal cavity

Unlike pyramidal malignancies, this refers to tumors of the nose and paranasal sinuses. Damage to the internal part of the body is a rather rare phenomenon. According to unofficial data of domestic and foreign oncologists, such diseases account for about 2% of all cancers of the upper respiratory organs. Males are at risk.

Epithelioma is a generic name for epithelial neoplasms of the nasal cavity. These tumors arise in the sinuses and on the mucous membrane of the cylindrical ciliated epithelium. One of the types of cancer of the internal cavity, as well as the pyramids of the nose, are cylindromas. Unlike epitheliomas, cylindromas are delimited from neighboring tissues by a kind of capsule. Cavity epitheliomas are observed mainly in patients older than 50 years, while sarcomas can affect even in childhood.

Benign formations

Less life-threatening pathological formations can also develop in the nasal cavity. Benign tumors of the nose are a group of cavitary atypical structures that originated from different tissues. Non-malignant tumors are characterized by the absence of ulcers, bleeding and metastases.

To differentiate benign pathologies of the nasal cavity from malignant ones, complex complex diagnostics will be required. The most common non-cancerous tumors of the nasal cavity are:

• papillomas.
• Angiomas.
• Polyps (tumors of the sinuses).
• Chondromas.
• Osteomas.
• Fibroids.
• adenomas.
• Lipomas.

Pathologies can be located in any part of the cavity. The development of a benign formation is most often indicated by such symptoms as:

• nasal congestion;
• difficulty breathing;
• impaired sense of smell;
• sensation of the presence of a foreign body in the nose;
• headache;
• mucous or purulent discharge.

Diagnosis of cancerous and non-malignant tumors

To diagnose benign formations in the nasal cavity, rhinoscopy is performed and samples of pathological tissues are sent for histological examination. If malignant tumors of the sinuses are suspected, the patient is prescribed x-ray of the sinuses with a contrast agent, pharyngoscopy, CT of the skull. After confirming the good quality of the tumor, the patient must definitely consult an ophthalmologist.

Non-malignant formations in the nose are treated by excision using electrocoagulation, laser destruction, or sclerotherapy. If the spread of cancerous metastases is suspected, in order to establish their localization, the patient is prescribed an ultrasound examination of the abdominal organs, MRI of the brain, and fluorography of the lungs.

In the predominant number of cases, benign tumors of the nasal cavity are non-invasive, grow slowly, but the need for their treatment cannot be neglected, since under the influence of certain factors they become prone to malignancy. If polyps, adenomas or fibromas are found in the cavity, treatment should be started immediately. At the same time, you need to know that some types of pathologies are often complicated by relapses after removal, for example, papillomas and polyps.

The most dangerous of benign tumors are considered to be osteomas and chondromas, which not only destroy surrounding tissues, but also have a risk of degeneration into malignant forms. After the removal of such neoplasms, patients often have external facial defects. In addition, after the removal of the tumor, an irreversible violation of nasal breathing and loss of the ability to distinguish odors are possible.

Causes of tumors

Many factors that are still not fully understood can cause the development of atypical cells in the structure of nasal tissues. Examining the medical history of oncological patients, analyzing their anamnesis taking into account age features health and social conditions, doctors were able to make the most probable assumptions about the nature of the origin of nasal cancer.

Harmful Conditions labor activity is one of the most common causes of cancer. The constant ingress of toxic and chemical substances into the body through the respiratory system creates favorable conditions for the degeneration of cells and the launch of malignant processes. Most often, a tumor in the nose (photo can be seen in the article) is detected in workers in the woodworking, flour-grinding industry, workers in tanneries, auto repair shops. Vapors of chromium, nickel, and other chemical compounds used in production have a strong irritating effect on the nasal mucosa.

Another cause of cancer is untreated chronic diseases of the paranasal sinuses (rhinitis, sinusitis). The development of the tumor is promoted by a persistent inflammatory process and the activity of pathogenic microflora. Alcohol abuse and smoking can make a negative contribution.

According to statistics, drug addicts and drug addicts are most likely to develop a nose tumor - people who achieve intoxicating euphoria by inhaling glue vapors, dry powdered drugs through the nose. Trauma to the cranial bones can cause cancer. In isolated cases, even a serious disease can provoke the development of a malignant process.

How to quickly cure a tumor and what are the patient's chances of recovery? No one can answer this question with certainty. The development of cancer, as well as the success of its cure, largely depend on the functioning of the immune system. The weaker the immune system, the fewer obstacles encountered in the development of atypical cells.

Symptoms of a tumor in the nose

The reason for the late diagnosis of cancer is the concealment of its symptoms. In the initial stages, the disease is not much different from the course of respiratory and viral infections of the upper respiratory tract. A blurred clinical picture often lulls the vigilance of people, as a result of which the opportunity to start the fight against the disease at an early stage is missed, and further treatment becomes difficult. Cancer makes itself felt by the appearance of the following signs:

• difficulty breathing through the nasal passages for a long time, while vasoconstrictor drugs do not have any therapeutic effect;
• discharge of contents from the nose with an admixture of blood and pus;
• painful ulcerations on the nasal mucosa;
• periodic bleeding;
• ear pain due to chronic inflammation of the middle ear;
• headache;
• hyposmia - deterioration in the sensitivity of olfactory receptors;
• numbness of the face in the nose and paranasal sinuses.

Cancer, unlike benign formations, develops at lightning speed. As the disease progresses and the size of the tumor increases, others gradually join the indicated symptoms:

• there are severe pains in the nasal cavity that cannot be stopped with conventional painkillers;
• pain constantly radiates to upper jaw it seems as if all the teeth hurt;
• hearing acuity decreases, extraneous noises pursue;
• develops photophobia, increased lacrimation, blepharitis;
• the nasal pyramid is deformed, the appearance of the face changes.

When cancer cells begin to grow into the masticatory muscles, the process of eating will be significantly hindered. It is difficult for patients in the terminal stage to even open their mouths normally. If the neoplasm in the sinuses reaches a significant size (more than 2-3 cm), it begins to put pressure on the brain. A tumor of the nose is accompanied by ulcerative lesions of the oral mucosa, loss of teeth.

Externally localized cancer is detected much faster than abdominal cancer. But even at an early stage, an experienced otolaryngologist will notice any of the tumors. All formations initially resemble small nodules, bumps. It is impossible to independently detect a cancerous tumor in the nasal cavity, therefore, if you suspect a disease, you should immediately consult a doctor.

General signs of oncology of the nasal cavity

In addition to the specific symptoms of cancer, characteristic manifestations join the course of the disease:

• rapid fatigue and weakness;
• nausea and dyspeptic disorders;
• weight loss in a short period;
• loss of appetite;
• a fetid odor when breathing, which is noticeable even at a distance (may indicate the decay of the neoplasm).

In adults and children, nasal tumors affect the lymph nodes, so their enlargement and inflammation can be considered another indirect symptom of cancer.

The main stages of the tumor process

After confirming the diagnosis, the patient is assigned the appropriate treatment tactics, depending on the stage of the disease. Oncologists distinguish several stages of the malignant process:

• Initially, a cancerous tumor develops in the epithelial layers, without affecting the bone structures and lymph nodes.
• In the second stage, the tumor is still within the nose, but its cells can already be found in nearby bones and cartilage.
• The third stage of a malignant disease is characterized by bone destruction and metastatic lesions of neighboring tissues and organs.
• The terminal (fourth) stage is accompanied by the penetration of cancer cells into the bones mandible and cheekbones. At this stage of the disease, the skin of the face is affected, and the lymph nodes located nearby become immobile and coalesce with soft tissues, which further leads to the formation of infiltrate and bleeding ulcers.

How to help the patient: methods of treatment

Therapy of oncological diseases is selected individually for each patient, taking into account the stage of tumor formation, its exact localization, the presence of metastasis foci and the general condition of the patient. The decision on the surgical treatment of a nasal tumor is made by doctors, as a rule, at the initial stages of cancer and only if the pathology is located in the nasal pyramid.

But even with indications for surgery, in most cases they resort to a combined approach in the treatment of cancer. First, the patient undergoes a course of radiation and chemotherapy, then the tumor is removed through the nose. Some time after surgery, the patient will have to undergo radio- and chemotherapy again.

In the treatment of cancer of any localization, doctors fight for the life of the patient, while questions of aesthetics appearance rise to the background. Complete removal of the tumor can lead to severe facial disfigurement. The volume of tissues removed will depend on the degree of involvement of nearby structures in the tumor process. In severe cases, the patient can completely remove the upper jaw and eye sockets. In the presence of brain metastases, the possibility of surgical removal of cancer is determined by a neurosurgeon. After successful operation and recovery, the patient will have to undergo treatment by a plastic surgeon.

In the rehabilitation period, a complex of medications is prescribed to the patient in order to facilitate well-being and activate tissue regeneration. As a rule, these are antibiotics, hemostatic and vasodilators, hormonal and immunostimulating drugs. After the control diagnostics, which confirms the success of the treatment, the patient is put on a dispensary record, which involves the passage of a periodic preventive examination. If a recurrence is detected, the treatment is repeated.

The operation to remove the tumor may be ineffective if performed at an advanced stage of cancer with complications. In this case, patients are prescribed only palliative therapy to improve the quality of life.

What is the forecast

The chances of a patient's recovery are determined by the timeliness of the treatment. If the nose tumor was detected in the first stages, the probability of positive dynamics is the highest. Thus, the use of a combined approach in treatment (radiotherapy, chemotherapy and surgery) allows us to talk about a five-year survival rate of more than 80% of patients. If the pathology was detected at a stage when the cancer had already begun to spread to the lymph nodes, the chances of overcoming the five-year threshold are minimal. Persons who seek help in the fourth stage of nasal sarcoma, in most cases, die within a year.