title: Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma.
abstract: BACKGROUND
  It is well documented that inverted papillomas (IP) have a localized attachment site. Still, instead of concentrating on the attachment site, endoscopic surgeons often perform an extended resection similar to the one achieved after external surgery.
  
  
  OBJECTIVE
  Our objective was to evaluate an attachment-oriented endoscopic surgical strategy and to determine IP attachment diameter and location.
  
  
  METHODS
  A prospective study was conducted. Thirty-three consecutive patients who underwent endoscopic IP excision (2001--2007) were enrolled. Thirty patients had adequate follow-up. Attachment diameters were measured in 25/33 patients. Surgery included debulking, identifying the precise mucosal attachment site, subperiosteal dissection and excision of the attachment, frozen section control, and resection/drilling of underlying bone.
  
  
  RESULTS
  The mean measured attachment diameter (n = 25) was 8.4 +/- 6 mm (range, 3-23 mm). Attachment locations included maxillary sinus (39%), ethmoid sinus (21%), nasal cavity (21%), frontal sinus (6%), sphenoid sinus (6%), lamina papyracea (3%), and cribriform plate (3%). The mean follow-up (n = 30) was 40 +/- 21 months. Three patients had Krouse stage 1, 10 patients had stage 2, and 17 patients had stage 3. Nine patients had undergone previous surgeries. After attachment-oriented endoscopic surgery, three patients had persistent disease. Nasolacrimal duct stenosis was the only complication (n = 1).
  
  
  CONCLUSIONS
  Even advanced IP have small attachments. Their Identification facilitates efficacious resection with minimal morbidity.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. jeroy@bezeqint.net
authors.forename: Roee
authors.initials: R
authors.lastname: Landsberg
authors.forename: Oren
authors.initials: O
authors.lastname: Cavel
authors.forename: Yoram
authors.initials: Y
authors.lastname: Segev
authors.forename: Avi
authors.initials: A
authors.lastname: Khafif
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018308:Papilloma, Inverted / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D011446:Prospective Studies