Presentation

From the maxilla the tumour may spread into the nasal cavity producing nasal obstruction and discharge (often serosanguinous). Anterior spread along the infra-orbital canal may produce pain and paresthesia. Orbital involvement produces displacement of the globe with:

Inferior involvement of the dental roots may lead to loosening of the teeth and/or a malignant oro-antral fistula or a mass in the hard palate. Posterior extension into the pterygoid and infra-temporal fossa produces pain and trismus.

Spread from the ethmoid sinuses will involve the nasal cavity, contralateral ethmoid, and orbit with symptoms as described. Superior extension into the anterior cranial fossa is generally asymptomatic. The middle cranial fossa may be involved by direct spread from the anterior cranial fossa or orbital apex, whence a cavernous sinus syndrome may arise. Nasal cavity lesions, in addition to nasal symptoms, may spread posteriorly to obstruct the Eustachian tube producing a unilateral serous otitis media or anteriorly to erode and displace the nasal bones in the region of the glabella.

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