The Integrated Surgical Strategy for Removal of Inverted Papilloma Involving the Maxillary Sinus According to the Site of Tumor Origin

Abstract

Background and Objectives The objective of this study is to determine the appropriate surgical approach for the resection of inverted papilloma (IP) involving the maxillary sinus (MS) according to the site of tumor origin in the MS. Subjects and Method Twenty-six patients who underwent surgery from January 2002 to April 2008 for IP originating from the MS were reviewed retrospectively in regard to the type of integrated surgical approach, site of tumor origin in the MS and the follow-up clinical results. Results Ten cases (38.4%) originated from medial wall of the MS; of these, four EES (endonasal endoscopic surgery), two EMM (endoscopic medial maxillectomy), two EES+CP (canine puncture), and two EES+CLA (Caldwell-Luc's approach) were performed. EES+CP procedure were performed in all three cases (11.5%) of the anterior wall origin. One case (3.8%) that originated from the posterolateral wall was removed by EES+CLA. Four cases (15.3%) originated from the medial-posterolateral wall. Two EES, and one each of EMM and EES+CLA were performed. Three cases (11.5%) originated from the superior-posterolateral wall, of which two cases were removed by EES and the other by EES+CLO (Caldwell-Luc's operation). Two cases of inferior-anterior wall and inferior-posterolateral wall were removed by EES+CLO and EES+CLA, respectively. EES+CLO were performed for three cases of the whole wall origin (11.5%). Two recurrent cases were found in each of EES and EES+CLO. Conclusion IP originated from the MS were successfully managed by EES alone or EES combined with other approaches such as CP, CLA, CLO and EMM. These integrated approaches need to be applied in a gradual manner from less severe to more aggressive cases.