Surgical Treatment of Inverted Papilloma

Abstract

Inverted papilloma (IP) is the most common benign tumor of the nose and the paranasal sinuses and constitutes almost 0.5% to 4% of the primary nasal tumors. In this study, our objective was to retrospectively review the results of surgical treatment of IP.Sixty-eight patients with a histopathologically proven diagnosis of IP were retrospectively evaluated. Two patients who had an associated squamous cell carcinoma were excluded from the study. Ten patients were operated on for revision surgery, and 56 eventually had a primary tumor. Patients operated on for primary tumor were included in this study. Nasal obstruction was the most frequent symptom observed in 50 patients (89%). The origin of the tumor was most common at the maxillary sinus, the lamina papyracea, and the ethmoid sinus. Endoscopic endonasal resection, endoscopic endonasal resection with the Caldwell-Luc procedure, medial maxillectomy after lateral rhinotomy (LR), and endoscope-assisted medial maxillectomy with LR approaches were used. The patients operated on only with medial maxillectomy after an LR procedure have a recurrence rate of 28% (2 patients). Endoscopic endonasal resection has a recurrence rate of 9% (2 patients). Recurrence observed after endoscopic endonasal resection with Caldwell-Luc procedures was 7% (1 patient). One recurrence (8%) was determined after an endoscope-assisted medial maxillectomy after LR. No major postoperative complications were observed after surgery.In conclusion, IP can be treated both with internal and external approaches. The type of surgery should be determined according to the tumor stage. Combined internal and external approaches have less recurrence rates in advanced cases. Endoscopic endonasal resection should be used in early-stage tumors.