Endoscopic management of inverted papilloma

Inverted papillomas are uncommon benign tumors that may occur in the sinonasal tract. Because of their tendency towards recurrence and their potential for malignant transformation, complete en bloc resection has been the standard treatment modality. With the application of minimally invasive surgical techniques in the management of sinonasal disease processes, transnasal endoscopic removal of inverted papillomas is gaining in acceptance. The following represents a review of the current literature regarding sinonasal inverted papilloma and its clinical management.

The recent literature has further refined the technique of endoscopic resection of inverted papillomas by delineating essential principles and applying new technologies, such as image guidance and angled endoscopic drills. Modified approaches and methodology have been described to address tumors originating in particular anatomic locations. At the same time, new information relevant to the diagnosis and surveillance of inverted papillomas has been published, regarding the role of imaging, serum tumor markers, and human papillomavirus.

Growth in experience with the endoscopic management of inverted papillomas has led to evolving technical improvements and innovations. In most tumor locations, the completeness of resection achieved by a skilled endoscopic surgeon is equivalent, if not superior, to that attained with an open approach. In some instances, an endoscopic exploration with tumor resection may help define the site of tumor attachment and direct adjunctive open procedures when indicated. Long-term outcomes studies with sizeable patient cohorts will be needed to define the role of various surgical strategies in the optimal management of inverted papilloma.