Melbourne Dental School - Theses

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Author: Bobinskas, Alexander × End date: 2019 × Start date: 2014 × Subject: oral cancer ×

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    Squamous cell carcinoma involving the maxilla: a 20 year retrospective review
    Bobinskas, Alexander ( 2015)
    Background: Squamous cell carcinoma (SCC) may primarily involve the maxilla via tumours of maxillary sinus origin or via tumours arising from the hard palate or maxillary alveolus within the oral cavity. Both of these presentations represent a small subset of head and neck squamous cell carcinoma making SCC involving the maxilla a relatively uncommon disease. Aims: To examine our institution’s experience with SCC involving the maxilla and to compare the outcomes of patients with SCC involving the maxilla via the oral cavity with patients presenting with maxillary sinus SCC. In addition to this we evaluated our experiences regarding cervical metastases in patients with being treated for maxillary sinus SCC. Materials and methods: A retrospective review of patients with SCC involving the maxilla treated with curative intent via the Head and Neck Oncology stream at the Royal Melbourne Hospital between 1990 and 2010 was undertaken. Data collected was analysed to determine the influence of primary site on patient outcomes. Data was also examined to determine the incidence of cervical metastases at presentation and subsequent regional failure in patients with maxillary sinus SCC.   Results: Influence of site of origin on the outcome of squamous cell carcinoma involving the maxilla – oral versus sinus. When compared with tumours involving the maxilla via the oral cavity, maxillary sinus origin did not per se confer a poorer prognosis. Maxillary sinus tumours were however more likely to present with advanced T-stage (T3/T4) and were more likely to have positive margins after resection. Cervical metastases in maxillary sinus squamous cell carcinoma The incidence of clinically or radiographically detected cervical metastases in our patients was 11%. At our institution, the majority of patients treated for maxillary sinus SCC underwent elective neck irradiation, with an overall regional failure rate of 4%. Our results found that local recurrence rather than regional metastasis was the primary source of treatment failure Conclusions: Influence of site of origin on the outcome of squamous cell carcinoma involving the maxilla – oral versus sinus. Site of origin does not in of itself confer a poorer prognosis; rather maxillary sinus SCC is more likely to remain occult until locally advanced and given the complex anatomy of the midface obtaining adequate margins during surgical resection is more difficult. It is these factors rather than the site of origin that affect prognosis. Cervical metastases in maxillary sinus squamous cell carcinoma: Despite typically presenting with advanced T-stage, clinical or radiographic nodal involvement at the time of presentation was uncommon in patients with maxillary sinus SCC. In our study post treatment failure more commonly occurred at the primary site than as a result of regional metastases.