title: Bilateral aggressive inverted papillomas: A changing scenario.
abstract: OBJECTIVE
  The ideal management of bilateral, recurrent inverted papillomas is intriguing and often controversial. We describe the ideal management of such tumors.
  
  
  METHODS
  Retrospective, case series
  
  
  METHODS
  The three patients in this series inspite of several surgical procedures in the past had recurrences and behaved in an aggressive fashion. The patients underwent surgical excision by either bilateral lateral rhinotomy, midfacial degloving or craniofacial approaches.
  
  
  RESULTS
  One patient who underwent excision by midfacial degloving approach had recurrence. This was removed by lateral rhinotomy approach. Two patients were subjected to radiotherapy due to the presence of mitotic figures on histopathology. All the patients are asymptomatic at 6 months follow-up.
  
  
  CONCLUSIONS
  Aggressive inverted papillomas may have varied presentation. They could have multiple recurrences, bilateral presentation or intracranial extension. They can be effectively managed with bilateral lateral rhinotomy or cranio-facial resection. Adjuvant radiotherapy has a role in controlling recurrences.
authors.affiliation: Department of Otolaryngology, Head and Neck surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India 160 012.
authors.forename: Naresh K
authors.initials: NK
authors.lastname: Panda
authors.forename: K
authors.initials: K
authors.lastname: Saravanan
authors.forename: R K
authors.initials: RK
authors.lastname: Verma
authors.forename: Vankalakunti
authors.initials: V
authors.lastname: Mahesha
keywords: Bilateral lateral rhinotomy; Bilateral papilloma; Intracranial extension