Ohngren described a difference in the prognosis of maxillary sinus malignancies depending on their anatomic location within the sinus.7 He divided the maxillary sinus into 2 halves by an oblique, imaginary plane passing through the medial canthus of the eye and the angle of the mandible (Figure 11-1). Ohngren observed that this plane separates the topographically more favorable tumors which are anterior and inferior to the plane, from those of more unfavorable character which are superior and posterior to the plane. Ohngren's early insight into the topographical importance of maxillary sinus carcinoma proved to be highly significant. Cancers of the maxillary sinus originating anterior and inferior to this plane (in the "infrastructure"), present earlier with symptoms and are more amenable to surgical resection with a better overall prognosis. In contrast, malignancies originating posterior and superior to this plane, (in the "suprastructure"), tend to develop symptoms later in the course of the disease and are challenging to resect surgically due to the anatomic proximity of the ptery-gopalatine fossa, infratemporal fossa, orbit, and skull base. These principles of maxillary sinus carcinoma behavior continue to be reflected in the American Joint Committee for Cancer (AJCC) staging system for maxillary sinus carcinoma.8
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