title: Is radical surgery of an inverted papilloma of the maxillary sinus obsolete? a case report.
abstract: BACKGROUND
  Sinonasal inverted papilloma is a locally aggressive tumor arising from the Schneiderian membrane which lines the nasal cavity and paranasal sinuses. Aggressive surgical approaches, such as lateral rhinotomy, were used until recently for complete removal of the inverted papilloma. Currently, endoscopic resection is the gold standard in the treatment of inverted papilloma. However, there are situations that justify an open approach. For example there are studies that report a higher postoperative recurrence rate after endonasal endoscopic resection, particularly in the treatment of recurrent diseases. While endoscopic resection performed by an experienced surgeon is definitely a minimally invasive therapy, an open approach is not necessarily associated with functional and aesthetic disadvantages. This case report describes the treatment of inverted papilloma by an open approach. This has been described before but the new gold standard of endoscopic resection has to be taken into account before any treatment decision is made nowadays.
  
  
  METHODS
  Contrast-enhanced magnetic resonance imaging of the head and neck area was indicated in a 72-year-old white German man who presented with suspected squamous cell carcinoma of his lower lip. Magnetic resonance imaging additionally revealed a 3×2 cm2polycyclic arranged mucosal thickening with cystic and solid contrast affine shares at the antral laterocaudal area of his right maxillary sinus, extending from his right lateral nasal wall to his maxillary sinus floor. He received antral polypectomy with medial maxillectomy via a unilateral LeFort I osteotomy approach. His pterygoid plate was preserved. A histological examination demonstrated a tumor composed of hyperplastic squamous epithelium protruding into the stroma (surface epithelial cells grew downward into the underlying supportive tissue), thus producing a grossly convoluted cerebriform appearance. Two weeks later, the patient regained a well-formed maxilla without any restrictions. He has remained disease-free for 25 months following the surgery and surveillance was continued in our tumor clinic.
  
  
  CONCLUSIONS
  Endoscopic resection of an inverted papilloma continues to be the gold standard. However, some cases require a radical approach. This does not necessarily increase patient morbidity.
authors.affiliation: Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
authors.forename: Vedat
authors.initials: V
authors.lastname: Yildirim
authors.affiliation: Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
authors.forename: Niels Christian
authors.initials: NC
authors.lastname: Pausch
authors.affiliation: Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Halama
authors.affiliation: Private Practice for Oral and Maxillofacial Surgery, Archstr. 12, 8400, Winterthur, Switzerland. info@luebbers.ch.|Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland. info@luebbers.ch.
authors.forename: Heinz-Theo
authors.identifier: http://orcid.org/0000-0002-2884-4008
authors.initials: HT
authors.lastname: Lübbers
authors.affiliation: Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Yildirim
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000473:pathology*; D008444:Maxillary Sinus Neoplasms / Q000473:pathology* / Q000601:surgery; D018308:Papilloma, Inverted / Q000473:pathology* / Q000601:surgery; D059546:Sinus Floor Augmentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Caldwell–Luc; Case report; Endoscopic resection; Inverted papilloma; Radical approach