Hard cymbal in a semi-circular bulge

Introduction

Introduction

The semicircular bulge of hard palate is a symptom that occurs when the maxillary sinus malignant tumor grows and grows, affecting the surrounding tissue structure and function. The early tumor is small and is limited to a certain part of the sinus cavity without obvious symptoms. With the development of the tumor, the following symptoms have appeared: unilateral pus and bloody nose: cheek pain or numbness (tumor invasion of the infraorbital nerve caused by cheek pain or numbness) may be the first symptom, unilateral progressive nasal congestion (tumor) Squeeze causes the inner wall of the nasal cavity to move inward or destroy the outer wall of the nasal cavity to invade the nasal cavity. The unilateral maxillary sinus molars are painful or loose (caused by the tumor invading the alveolar).

Pathogen

Cause

The cause of the hard palate in a semi-circular bulge:

Caused by a malignant tumor of the maxillary sinus.

Examine

an examination

Related inspection

Glossal nerve examination of nasopharyngeal MRI

The examination of the hard palate in a semicircular bulge:

Malignant tumors of the maxillary sinus are asymptomatic because of their large cavities and different primary sites, which are more common than those found during the examination. When the tumor grows up and affects the surrounding tissue structure and function, it can produce corresponding symptoms and signs. If it develops into the nasal cavity, there will be a stuffy nose, a sticky pus, a bloody nose and a smelly smell. Nasal examination revealed that the lateral wall of the nasal cavity moved to the nasal cavity. Sometimes there is a mass in the middle nasal passage or nasal cavity, which is a favorable time for biopsy to confirm the pathological diagnosis. Tumor invading the nasolacrimal duct can cause tears. Involving the anterior wall of the maxillary sinus, there is swelling of the cheeks, deformity and facial pain. The tumor infiltrates to the bottom. Patients often have toothache, swelling of the gums, loosening of the teeth, and semi-circular bulging of the hard palate. At this time, it is easily misdiagnosed as a dental disease, and its symptoms are aggravated after tooth extraction. The tumor can also develop on the posterior wall of the maxillary sinus, invading the pterygopalatine fossa, causing difficulty in opening the mouth If the tumor destroys the inferior wall or enters the iliac crest, eye movement and visual impairment may occur. In the advanced stage of the tumor, the anterior sinus can be invaded through the ethmoid sinus and the eyelid, and the pterygoid fossa and the pterygopalatine fossa can be destroyed, thereby destroying the pterygopalatine fossa, or involving the infraorbital fossa, and entering the cranial fossa Symptoms such as mass, difficulty in opening mouth, neck bulge, intractable headache, and ear pain appear in the clinical internal iliac crest, suggesting that there may be a skull base or intracranial metastasis. About 1/2 of the malignant tumors of the maxillary sinus have lymph node metastasis. Caused by a malignant tumor of the maxillary sinus.

The early tumor is small and is limited to a certain part of the sinus cavity without obvious symptoms. With the development of the tumor, the following symptoms have appeared: unilateral pus and bloody nose; pain or numbness in the cheeks (tumor invasion of the infraorbital nerve caused by side cheek pain or numbness. It may be the first symptom, which is very important for early diagnosis) Unilateral progressive nasal obstruction (tumor extrusion causes the lateral wall of the nasal cavity to move or destroy the lateral wall of the nasal cavity to invade the nasal cavity); unilateral maxillary sinus molar pain or looseness (caused by tumor invasion and alveolar).

The maxillary sinus malignant tumor destroys the sinus wall in the late stage and spreads to adjacent tissues, which can cause the following symptoms:

(1) Buccal bulge: Tumor compression destroys the anterior wall, which can cause the cheeks to bulge, invade the soft tissue and skin of the cheeks, and can cause fistula or ulceration.

(2) ocular symptoms: the tumor compresses the tears of the nasolacrimal duct; the upward pressing of the sacral floor can shift the eyeball upward.

(3) Hard bulge: The downward expansion of the tumor can cause the hard palate and the labial sulcus to have a semi-circular bulge, even ulceration, thickening of the alveolar, and loosening or shedding.

(4) difficulty in opening the mouth: When the tumor is invaded into the wing and the pterygoid muscle, refractory neuralgia and difficulty in opening the mouth may occur.

(5) Skull base involvement: internal mass may occur, or there may be difficulty in opening the mouth, swelling of the ankle, headache, earache and other symptoms.

(6) cervical lymph node metastasis: occurs in the later stage.

Diagnosis

Differential diagnosis

Hard palate is a semi-circular bulge that is confusing

Hard palate in a semi-circular bulge should be distinguished from various sinus tumors:

(1) Benign tumors:

Benign tumors of the nasal cavity and sinus are more common in papilloma, fibroangioma, hemangioma and osteoma, and there are fewer nasal mixed tumors, chondromas, neurofibromas and enamel tumors. In addition, lymphangioma, myxoma, adenoma, leiomyoma, and lipoma can occur, but it is quite rare.

(2) Malignant tumors:

The malignant tumors of the nose and sinus have the highest incidence of cancer, about 4 to 9 times that of sarcoma. Among them, squamous cell carcinoma is the most common, and basal cell carcinoma, mucoepidermoid carcinoma, adenocarcinoma, and undifferentiated carcinoma are less. Other malignant tumors may include malignant lymphoma, extramedullary plasmacytoma, fibrosarcoma, malignant melanoma, and olfactory neuroblastoma.

Malignant granuloma, also known as midline malignant reticulosis (MMR) or lethal midline granuloma, is a more important disease of the nose, which can be seen at all levels of age. However, the incidence rate is the highest before and after the age of 40, and most of them are male. Patients often have irregular fever, nasal congestion, nasal discharge and purulent symptoms, swelling of the nose, necrosis and ulceration in the nose. The lesions are further expanded to destroy soft tissues, cartilage and bone, leading to perforation of the nasal septum and hard palate. Some patients may also have facial skin damage. Terminal patients can develop cachexia. The short course of disease is only 1 month, and the elderly can be more than 10 years, but most of them are within 1 year. Histopathologically, the most prominent lesion is characterized by a large number of atypical lymphoid cells in the diseased tissue mixed with varying numbers of neutrophils, lymphocytes, plasma cells, and monocytes. At the same time, there are varying degrees of coagulative necrosis. The heterotypic lymphoid cells vary in size, have different morphologies, irregular nucleus, deep-stained or chromatin in a fine network, and may have one or more small nucleoli with more mitotic figures. These cells often infiltrate the mucosal epithelium and blood vessels, and the lumen of the affected blood vessels narrows, and thrombosis can also be seen in some blood vessels. Immunohistochemical staining can be used to demonstrate that atypical lymphoid cells can express T cell differentiation antigens. It is currently believed that this disease is a peripheral T-cell lymphoma derived from the midline mucosa-associated lymphoid tissue. Recent studies have found that EBV-DNA is present in diseased tissues of some T cell tumors or on their tumor cells. Recently, an in situ hybridization test of MMR lesions with an oligonucleotide probe (EBER oligonucleotide probe) for small RNAs encoded by Epstein-Barr virus has been found, and the detection rate of EB virus occult infection is 78.9%. Therefore, it is speculated that the occurrence of this disease may be related to EB virus infection.

Malignant tumors of the maxillary sinus are asymptomatic because of their large cavities and different primary sites, which are more common than those found during the examination. When the tumor grows up and affects the surrounding tissue structure and function, it can produce corresponding symptoms and signs. If it develops into the nasal cavity, there will be a stuffy nose, a sticky pus, a bloody nose and a smelly smell. Nasal examination revealed that the lateral wall of the nasal cavity moved to the nasal cavity. Sometimes there is a mass in the middle nasal passage or nasal cavity, which is a favorable time for biopsy to confirm the pathological diagnosis. Tumor invading the nasolacrimal duct can cause tears. Involving the anterior wall of the maxillary sinus, there is swelling of the cheeks, deformity and facial pain. The tumor infiltrates to the bottom. Patients often have toothache, swelling of the gums, loosening of the teeth, and semi-circular bulging of the hard palate. At this time, it is easily misdiagnosed as a dental disease, and its symptoms are aggravated after tooth extraction. The tumor can also develop on the posterior wall of the maxillary sinus, invading the pterygopalatine fossa, causing difficulty in opening the mouth If the tumor destroys the inferior wall or enters the iliac crest, eye movement and visual impairment may occur. In the advanced stage of the tumor, the anterior sinus can be invaded through the ethmoid sinus and the eyelid, and the pterygoid fossa and the pterygopalatine fossa can be destroyed, thereby destroying the pterygopalatine fossa, or involving the infraorbital fossa, and entering the cranial fossa Symptoms such as mass, difficulty in opening mouth, neck bulge, intractable headache, and ear pain appear in the clinical internal iliac crest, suggesting that there may be a skull base or intracranial metastasis. About 1/2 of the malignant tumors of the maxillary sinus have lymph node metastasis.

Caused by a malignant tumor of the maxillary sinus. The early tumor is small and is limited to a certain part of the sinus cavity without obvious symptoms. With the development of the tumor, the following symptoms have appeared: unilateral pus and bloody nose; pain or numbness in the cheeks (tumor invasion of the infraorbital nerve caused by side cheek pain or numbness. It may be the first symptom, which is very important for early diagnosis) Unilateral progressive nasal congestion (tumor squeezing causes the lateral wall of the nasal cavity to move or destroy the lateral wall of the nasal cavity to invade the nasal cavity); unilateral maxillary sinus molar pain or looseness (tumor invasion and alveolar) maxillary sinus malignant tumor Late destruction of the sinus wall, spreading to adjacent tissues, can cause the following symptoms:

(1) Buccal bulge: Tumor compression destroys the anterior wall, which can cause the cheeks to bulge, invade the soft tissue and skin of the cheeks, and can cause fistula or ulceration.

(2) ocular symptoms: the tumor compresses the tears of the nasolacrimal duct; the upward pressing of the sacral floor can shift the eyeball upward.

(3) Hard bulge: The downward expansion of the tumor can cause the hard palate and the labial sulcus to have a semi-circular bulge, even ulceration, thickening of the alveolar, and loosening or shedding.

(4) difficulty in opening the mouth: When the tumor is invaded into the wing and the pterygoid muscle, refractory neuralgia and difficulty in opening the mouth may occur.

(5) Skull base involvement: internal mass may occur, or there may be difficulty in opening the mouth, swelling of the ankle, headache, earache and other symptoms.

(6) cervical lymph node metastasis: occurs in the later stage.