Endoscopic Resection of Anterolateral Maxillary Sinus Inverted Papillomas

Abstract

Objectives: Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell-Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes concerning the endoscopic surgical resection of anterolateral maxillary sinus IPs. Methods: A prospective review of patients presenting with maxillary sinus IPs pedicled on the anterior and/or lateral walls was performed. Demographics, pedicle location, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated. Results: Over 6 years, 35 patients (avg. age 56) underwent EMM for maxillary sinus IPs located on the anterolateral maxilla. Most patients (69%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70° endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell-Luc approaches were required. Pathologic dysplasia was identified in 8 subjects, and 3 had carcinoma. There were no recurrences with a mean disease-free interval of 27 months (6-72 months). Conclusions: In the present study EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location previously considered accessible only with external procedures.