Frontal sinus inverted papilloma: Osteoplastic flap approach

Abstract

Inverted papilloma of sinonasal system is a benign tumour comprising of 0.5% to 4% of all nasal tumours having locally aggressive features. Recurrence is common and can cause bone destruction. Clinically, the most common presentation is unilateral nasal obstruction. Isolated frontal sinus inverted papilloma maybe hidden for long time without any symptoms. A 55 yr old man with recurrent sinonasal polyposis who underwent endonasal surgery on multiple occasions presented to us with complaints of unilateral nasal obstruction, anosmia, fronto-temporal headache since 9 years which aggravated during past 6 months. Following admission CT – Para Nasal Sinuses showed sinonasal polyposis involving bilateral frontal , right maxillary sinuses with hyperdense lesions in frontal sinuses and multiple sinus wall erosions with exposure of dura. Patient was planned for Functional Endoscopic Sinus Surgery and osteoplastic flap without frontal sinus obliteration after adequate premedication. Intra-operatively frozen section revealed inverted papilloma histopathologically. Complete clearance of tumour was achieved via osteoplastic approach.In our case complete excision of the mass was very important because recurrence after surgery is between 25% -35% for inverted papillomas. There are difficulties in handling papillomas of the frontal sinus. Despite advances in endoscopic sinus surgery these may require open surgical approach to the frontal sinus. So, osteoplastic flap approach provides a safe and effective way to deal with these pathologies.