Carcinoma of the Maxillary Antrum

Abstract

IN the treatment of carcinoma of the antrum a clear conception of the disease and accuracy of detail are essential to care successfully for the many complications which may be encountered. It is the purpose of this discussion to present the technical procedures by irradiation and surgery. At Memorial Hospital, recent advances in the diagnosis and treatment of carcinoma in general have been furthered by the development of a method for measuring the minimum dose of radiation delivered to the lesion, and by a method of immediate histologic diagnosis. Their application to carcinoma of the antrum, with the principles of surgical exposure and drainage, promises better results in the future, not only with the operable, but particularly with the inoperable cases. A review of the literature reveals only a small percentage of patients well five years from the first appearance of the lesion, after any type of treatment. Until recently the principal treatment has been surgical excision of the tumor-bearing area. In regard to the resection of the superior maxilla for carcinoma, Scudder said that even the most painstaking surgery rarely succeeds, and that success by this means is the exception rather than the rule. The primary cause for surgical failure is the inability to resect widely enough. An important secondary cause is the high operative mortality, which has been reported by Schley (31) to be from 12 to 13 per cent in America, and even higher in Europe. New (26) reported the results of a carefully selected series of cases treated at the Mayo Clinic. He concluded that coagulation over a long period of time by cautery in the form of soldering irons, followed by radium treatment, eliminated to a considerable degree the operative mortality, and cured more patients than operative methods had previously done. Quick (27, 28) formulated the present principles and demonstrated the actual possibilities of irradiation in the treatment of carcinoma of the antrum. He stated that radium and X-rays may be depended upon to eradicate the tumor tissue if applied accurately and uniformly throughout the growth in sufficient dosage. He stated further that surgery must be employed to provide exposure and drainage for radium application. The technical procedures employed at Memorial Hospital are based on these principles, and are found to be highly efficient. Symptoms Carcinoma of the antrum may produce signs referable to the nose, orbit, or teeth, long before an associated neoplasm is suspected. Empyema of the antrum is frequently suspected and conservative drainage instituted. The primary symptom frequently furnishes valuable evidence in determining the origin of the growth. For instance, if the growth arises in the ethmoid area or involves the floor of the orbit, ocular derangements, with swelling of the lids, and conjunctivitis and lacrimation, are prominent clinical features.