Dental considerations in diagnosis of maxillary sinus carcinoma: A patient series of 24 cases

Nomenclature of the symptoms of head and neck cancer: a systematic scoping review

Introduction

Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients' clinical problems more effectively and risk stratify the patient.

Method

The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms.

Results

There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings.

Discussion

Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician's decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign.

The Evaluation of Clinical Signs and Symptoms of Malignant Tumors Involving the Maxillary Sinus: Recommendation of an Examination Sieve and Risk Alarm Score

This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients (52.9%), and oroantral fistula was noted in 37 patients (55.9%). Additionally, 67 (95.7%) of the patients complained of nasal obstruction. Similarly, facial asymmetry was observed in 69 (98.6%) of the patients and double vision was observed in 24 (34.4%). Tumors of the maxillary sinus have a very insidious course of spread and uncertain clinical signs and symptoms. What makes diagnosis worse is the fact that the symptoms of these tumors are so well hidden in the sponge-like nature of the midfacial region that they are easily misinterpreted by patients. Therefore, diagnoses must be made early, dentists must be vigilant, and patients must be fully investigated at the slightest suspicion of a tumor, albeit benign.

Factors Contributing to Diagnosis and Prognosis in Sinonasal Malignancies

Objectives. This study was intended to explore and analyze the factors which affect the survival and prognosis of patients with malignant tumors of nasal cavity and sinus. Methods. Retrospective analysis was performed on the clinical data of 39 cases of malignant tumors of nasal cavity and sinus that met the requirements of the study. A follow-up study was performed on the patients for more than 36 months. Survival analysis was conducted via the Kaplan-Meier method and log-rank test. Cox regression model was used for multivariate analysis. Results. Gender, pathological type, treatment plan, clinical stage, and survival time of patients were different. Clinical stage was substantially related to the survival of patients ( $P<0.05$ ), which was an independent factor affecting prognosis. Conclusions. Early detection and comprehensive treatment of sinonasal malignancies can improve the prognosis and prolong the survival time of patients.

Primary Extra Nodal Diffuse Large B-Cell Lymphoma of the Maxillary Sinus with Symptoms of Acute Pulpitis

Diffuse large B-cell lymphoma not otherwise specified (DLBCL-NOS) is a subtype of large B-cell non-Hodgkin lymphoma with various clinical and pathological manifestations. DLBCL-NOS which primarily arises from maxillary sinus is rare and hard to diagnose due to unique anatomy. Here, we present a case of DLBCL-NOS that developed in the left maxillary sinus of a 72-year-old male, who presented with severe toothache that resembled acute pulpitis. The lesion was diagnosed and treated based on radiographs, histological, immunohistological examinations, and PET-CT analysis. Despite its rare incidence, DLBCL-NOS should still be included in differential diagnoses to rule out malignancy in cases of endodontic disease.