Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy.
OBJECTIVE
Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results.


METHODS
A prospective study and an integrated literature review.


METHODS
Seventeen consecutive patients with inverted papilloma who underwent endoscopic surgical excision, including medial maxillectomies and modified Lothrop procedures, were analyzed. Preoperative symptoms, computed tomography and magnetic resonance imaging findings, operative findings, tumor stage, and outcomes were recorded.


RESULTS
Thirteen male and four female patients presented with inverted papilloma between December 1993 and October 2001. Nasal obstruction was the most common presenting symptom (50%). Sixty-five percent of tumors were either stage II or stage III. Endoscopic resection was the primary treatment in 14 patients. Of the three patients who were secondarily treated endoscopically, one had recurrence and was subsequently found to have focus of squamous cell carcinoma. The overall recurrence rate was 6% and the incidence of malignancy was 6% (1 of 17). Recurrence rate for primary resections was zero (0 of 14). Five patients underwent endoscopic medial maxillectomies, and one patient with frontal sinus inverted papilloma was successfully treated with a modified endoscopic Lothrop procedure.


CONCLUSIONS
Endoscopic sinus surgery is a viable treatment alternative for sinonasal inverted papilloma. Recurrence rates for primary treatment are comparable to external approaches. Close follow-up of patients is mandatory because recurrence may be associated with malignancy.
Wormald
Peter John
PJ
Department of Surgery, Adelaide University, South Australia. peterj.wormald@adelaide.edu.au
Ooi
Eng
E
van Hasselt
C Andrew
CA
Nair
Salil
S
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D008297:Male; D008441:Maxillary Neoplasms / Q000601:surgery*; D008443:Maxillary Sinus / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D018308:Papilloma, Inverted / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery; D011446:Prospective Studies