[Diagnosis and treatment modalities in sinonasal inverted papillomas]

Today, etiology and pathogenesis of sinunasal inverted papillomas (IP) remain unknown. Surgical approaches and extension of surgical resections are still controversial.

In a retrospective study we reviewed the charts of 90 patients with sinunasal IP. Using external (n = 78) or endonasal (n = 12) approaches the tumors were completely resected in all cases. 57 cases were investigated for human papilloma virus (HPV) by immunohistochemistry.

60% of IP extended beyond one single paranasal sinus or the nasal cavity. 7% infiltrated adjacent anatomical structures (subcutis, orbit, anterior skull base). The recurrence rate was 19% after a mean interval of 8.2 month. Associated malignancy was found in 7 cases (7.7%). HPV was detected in 9% of IP. Postoperative complaints were noticed by 27% of endonasal and 35% of trans-facial operated patients.

Because of the advanced tumor stage in the majority of cases, usually a radical trans-facial surgical excision of IP is required. Endonasal approaches are feasible in selected cases, but surgery has to be more extensive compared to surgery for sinunasal polyposis. In the literature and in our experience IP is rarely associated with carcinoma (10% in literature) and the incidence of malignancy is not increased in recurrent IP. Using PCR, the prevalence of HPV ranges from 7 to 69% in the literature. Our immunohistochemical results support a rather low prevalence of HPV in IP.