Outcomes of the Extended Endoscopic Approach for Management of Inverted Papilloma

Abstract

Inverted papilloma (IP) is a benign tumour involving the paranasal sinuses. Given its tendency to recurrence and potential for malignancy, complete removal of the papilloma remains the treatment of choice. Since 1994, we have routinely employed an extended endoscopic approach for the resection of inverted papillomas. We present our methods and outcomes. The study was conducted in an academic tertiary care hospital-based practice. It is a retrospective review of patients treated by a single surgeon. IP was diagnosed by biopsy before surgery. With computed tomography and magnetic resonance imaging, we attempt to identify the sites of origin and extent of IP. Cases with previous medial maxillectomy or invasive disease are treated via the open approach. Otherwise, the extended endoscopic approach is used. The tumour is debulked, and its attachment points are identified. Endoscopic medial maxillectomy is then performed. If maxillary sinus involvement in its anterior, inferior, superior, or lateral portion is suspected, a Caldwell-Luc approach is performed to allow for mucosal excision and complete removal of the anterior lateral nasal wall. When the lamina papyracea or ceiling of the ethmoid or sphenoid sinus is involved, the bony wall is resected. The frontal recess can be approached via a Lynch incision or an endoscopic transorbital approach. Twenty-two patients were referred for IP. Nineteen patients were treated via the extended endoscopic approach. The average follow-up period was 23 (3-66) months. Only 3 of 19 patients (16%) presented with a recurrence or failure of initial surgery that required revision surgery. The extended endoscopic approach offers a safe, effective, and aesthetically acceptable treatment of most cases of IP.