This 72 year-old woman was referred by her family doctor because of a left proptosis with orbital pain of five week duration. A CT scan was performed and shown as above.

a. What is the diagnosis?

Left ethmoidal sinus carcinoma with orbital extension.

The CT scan shows a destructive lesion extending from the left ethmoidal sinus into the orbit causing proptosis.

b. How common does this condition affect the orbit?

Orbital involvement occurs in over 65% of patients with sinus carcinoma. The main symptoms are orbital pain and diplopia.

There is no distinctive diagnostic clinical signs or symptoms to signal early sinus carcinoma and therefore most tumours present in advanced stages.

80% of the sinus tumour is caused by squamous cell carcinoma with the remaining 20% caused by sarcoma. The maxillary sinus is the main site of these tumours followed by the ethmoidal sinus.

c. How would you manage this patient?

Treatment consists of extensive radical surgical excision and exenternation. Radiotherapy is not useful as squamous cell carcinoma of the sinus responds poorly.

The survival rate is poor for sinus carcinoma with orbital extension and this patient died six months after operation due to intracranial involvement.