Surgical Management of Sinonasal Inverted Papilloma

Abstract

Despite benign histological features, inverted papilloma (IP) of the sinonasal tract is aggressive, with local bone erosion and paranasal extent and high risk for local recurrence and associated malignancy. An external approach through a lateral rhinotomy is the gold standard of surgery, but surgical advances suggest that endonasal resection is a viable alternative. We retrospectively analyzed 35 cases of histologically confirmed IP treated from January 1987 to December 2007. The 22 men and 13 women had a mean age of 59 years (range: 18-78). Endoscopic procedures were conducted on 22 sides (63%). An external approach was taken on 13 sides (37%). Local recurrence rate was 27% (6/22) with endoscopic procedures and 31% (4/13) with an external approach. IP-associated malignancy (squamous cell carcinoma) was found in two cases (6%).Endoscopic and external approaches thus both achieve radical excision of tumors with similar recurrence rates.Our experience suggests the importance of selecting the approach appropriate for complete tumor resection.