Endoscopic treatment of inverted papilloma: safety and efficacy

Inverted papillomas of the nose and paranasal sinuses are uncommon neoplasms, characterized by their tendency to recur and by their association with malignancy. Over the past 25 years, the standard surgical treatment of inverted papillomas has involved extranasal, en bloc resections because of high recurrence rates with less extensive surgery. The past decade has witnessed an increasing number of reports documenting the successful treatment of inverted papilloma with endoscopic approaches. This investigation examines the role of endoscopic procedures in treating inverted papilloma.

The present article presents a thorough review of the literature relating to the history, pathology, diagnosis, and treatment of inverted papillomas of the nose and paranasal sinuses. It also provides a systematic review of the pertinent medical literature with pooled statistical analysis of data from 33 studies involving 1,426 patients.

The findings suggest that many cases of inverted papilloma can be treated successfully with low recurrence rates and less morbidity through endoscopic surgery, with results comparable to extranasal procedures. Less aggressive approaches to the sinuses and nonendoscopic intranasal procedures, such as the Caldwell-Luc, have unacceptable rates of recurrence and should be abandoned. A staging system for inverted papilloma and a logical approach to treatment are presented.