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Endoscopic resection of inverted papilloma: University of Miami experience
Sarita Kaza1, Robson Capasso, Roy R Casiano
1Department of Otolaryngology, University of Miami Hospital and Clinics, Miami, Florida 33136, USA.
Background:
The aim of this study was to evaluate the efficacy and safety of endoscopically resecting paranasal sinus inverted papillomas at a tertiary medical center.
Methods:
Over a 9-year period, 51 patients with a diagnosis of inverted papilloma underwent endoscopic resection at the University of Miami/Jackson Memorial Medical Center. The study group consisted of 14 women and 37 men with a mean age of 59 years (range, 20-88 years) enrolled in a clinical data base. All of the patients were followed endoscopically at regular intervals on an outpatient basis.
Results:
Endoscopic evidence of extensive papillomas involving the anterior and posterior ethmoid sinuses and at least one (usually the maxillary) dependent sinus was found in 60% of the cases. Extensive radiological disease (varying degrees of mucoperiosteal thickening or opacification of all five cavities) was evident in 50% of the cases. All but two had unilateral disease. An association with chronic inflammatory polyps (clinically and pathologically) was observed in 25 of 51 patients (49%). Follow-up ranged from 6 to 99 months (mean, 30 months). There have been seven recurrences (14%). Four of these have been managed in the office under topical anesthesia. Three recurrences were managed surgically in the operating room. All of the patients have been free of disease. Complications included an intraoperative CSF leak (three patients); temporary infraorbital hypesthesia (three patients); periorbital ecchymosis, hematoma, or cheek edema (four patients); and orbital symptoms (two patients). Carcinoma was found in four patients (8%) who received postoperative radiotherapy and remain free of disease.
Conclusion:
The endoscopic approach continues to provide at least equivalent short-term results as compared with external techniques for the removal of paranasal sinus inverted papilloma. The final cavity should allow for adequate postoperative surveillance and potential resection of recurrences in the office setting, without the need for a return to the operating room in most patients. The association of inverted papilloma with chronic inflammatory polyps and tobacco use warrants additional study.
Insights
Endoscopic resection of paranasal sinus inverted papillomas offers effective short-term outcomes. This minimally invasive technique facilitates office-based surveillance and recurrence management, reducing the need for repeat surgeries.
Area of Science:
- Otolaryngology
- Neurosurgery
- Oncology
Background:
- Paranasal sinus inverted papillomas are benign tumors with a propensity for recurrence and malignant transformation.
- Traditional external surgical approaches carry significant morbidity.
- Endoscopic resection has emerged as a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic resection for paranasal sinus inverted papillomas.
- To assess recurrence rates and management strategies.
- To identify potential associations with other sinonasal pathologies.
Main Methods:
- A retrospective review of 51 patients undergoing endoscopic resection over 9 years.
- Data collection included patient demographics, tumor characteristics, surgical outcomes, and follow-up.
- Patients were monitored via regular endoscopic examinations.
Main Results:
- 60% of cases involved extensive papillomas in multiple sinuses.
- 14% recurrence rate observed, with most managed non-surgically.
- 8% of patients had associated carcinoma, treated with radiotherapy.
Conclusions:
- Endoscopic resection provides comparable short-term results to external techniques for inverted papilloma.
- The endoscopic approach allows for effective postoperative surveillance and office-based recurrence management.
- Further research is needed on the association between inverted papilloma, chronic inflammatory polyps, and tobacco use.
