S278 – Management Strategies for Sinonasal Inverted Papilloma

Abstract

Objectives 1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy. Methods Retrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications. Results CT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow-up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively. Conclusions Inverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.