title: Surgical management of frontal sinus inverted papilloma: a systematic review.
abstract: OBJECTIVE
  Surgical management of frontal sinus (FS) inverted papilloma (IP) remains a significant challenge. This study systematically reviews the FS IP literature to delineate outcomes based on surgical strategy.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Cases for inclusion were identified by literature query for the terms frontal sinus and inverted papilloma between 1995 and 2010. Cases reported with sufficient outcomes data, defined as specific surgical approach and disease-free follow-up, were included. Statistical analysis was performed to identify significant risk factors for recurrence. The reported length of follow-up for each surgical approach was analyzed as an indicator of the strength of the reported literature for each approach.
  
  
  RESULTS
  Fifty-seven cases were identified in 13 studies, with 49 cases deemed adequate for additional analysis. Twenty-four cases (49%) were primary, and 25 (51%) were secondary (residual or recurrent disease) IP. Bilateral FS involvement was reported in eight cases (16.3%). Surgical approaches employed included endoscopic frontal sinusotomy (EFS) in 21 (42.9%), endoscopic modified Lothrop (EML) in 10 (20.4%), osteoplastic flap in 13 (26.5%), and endoscopic trephination and EFS in five (10.2%) patients. The overall rate of recurrence was 22.4%. Mean follow-up time was 27 months.
  
  
  CONCLUSIONS
  The recent reported literature of FS IP demonstrates high prevalence of recurrent and bilateral cases. Although statistical analysis of this accrued data is unable to delineate the best surgical approach for FS IP, more aggressive approaches frequently employed for secondary or bilateral disease may facilitate better disease control.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Walgama
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.forename: Pete S
authors.initials: PS
authors.lastname: Batra
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D018308:Papilloma, Inverted / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome