A 58-year-old man with carcinoma of the maxillary antrum is being staged. The tumour extends above Ohngren's line, involving the superior wall of the antrum and the orbit. What is the prognostic significance of this extension?

• A Better prognosis because suprastructural tumours are diagnosed earlier
• B Worse prognosis due to proximity to orbit, ethmoids and skull base ✓
• C No difference in prognosis between suprastructural and infrastructural growth
• D Better prognosis because such tumours are always radiosensitive

Explanation

Ohngren's line is an imaginary plane drawn from the medial canthus of the eye to the angle of the mandible, dividing the maxillary antrum into suprastructure and infrastructure. Tumours extending above this line involve the orbit, ethmoids, pterygopalatine fossa and skull base, making complete resection difficult and carrying a significantly worse prognosis. Infrastructural tumours, growing toward the alveolus and palate, present earlier with dental symptoms and are more often amenable to radical surgery.

Reference: Scott-Brown's Essential Otorhinolaryngology, 3rd ed.

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Written and medically reviewed by the StethoPrep medical team.