Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma

Area of Science:

• Otolaryngology
• Endoscopic Sinus Surgery
• Neurosurgery

Background:

• Inverted papillomas (IP) typically present with a localized attachment site.
• Current endoscopic surgical practices often involve extensive resections, mirroring open surgical approaches.
• This may lead to unnecessary tissue removal and increased patient morbidity.

Purpose of the Study:

• To evaluate an attachment-oriented endoscopic surgical strategy for inverted papillomas (IP).
• To determine the typical diameter and anatomical location of IP attachment sites.
• To assess the efficacy and safety of this focused surgical approach.

Main Methods:

• A prospective study enrolled 33 patients undergoing endoscopic IP excision.
• Attachment diameters were measured, and precise mucosal attachment sites were identified.
• The surgical technique involved debulking, subperiosteal dissection, attachment excision, frozen section control, and bone drilling.

Main Results:

• The mean attachment diameter was 8.4 mm (range, 3-23 mm) in 25 patients.
• Common attachment locations included the maxillary sinus (39%), ethmoid sinus (21%), and nasal cavity (21%).
• The attachment-oriented approach resulted in a low recurrence rate (3/30 patients) and minimal complications (1 nasolacrimal duct stenosis).

Conclusions:

• Inverted papillomas, even advanced ones, possess relatively small attachment sites.
• Identifying and targeting these specific attachments allows for effective endoscopic resection.
• This strategy minimizes surgical morbidity and improves patient outcomes.