Management of inverted papilloma

Area of Science:

• Otolaryngology
• Oncology
• Radiology

Background:

• Inverted papilloma (IP) management guidelines were last updated in 1981.
• The previous standard involved lateral rhinotomy with en bloc resection of the lateral nasal wall and schneiderian membrane.

Purpose of the Study:

• To update management strategies for inverted papilloma.
• To evaluate the role of computed tomography (CT) in planning surgical interventions for IP.
• To assess long-term outcomes, including recurrence rates and associated malignancies.

Main Methods:

• Retrospective review of 33 patients with inverted papilloma treated between 1969 and 1987.
• Analysis of surgical techniques, including lateral rhinotomy, medial maxillectomy, Caldwell-Luc/ethmoidectomy, and external ethmoidectomy.
• Utilization of computed tomography (CT) for preoperative disease extent determination.

Main Results:

• Seven out of 33 patients (21%) had associated squamous cell carcinoma.
• Twenty-two patients with IP alone were treated with medial maxillectomy.
• Three patients with localized disease were successfully treated with less extensive procedures (Caldwell-Luc/ethmoidectomy or external ethmoidectomy).
• High-resolution CT enabled precise surgical planning.
• Recurrence occurred in only one patient (4%) following lateral rhinotomy/medial maxillectomy.
• Average follow-up was 9.6 years.

Conclusions:

• Computed tomography (CT) scanning significantly improves preoperative assessment and surgical planning for inverted papilloma (IP).
• Lateral rhinotomy with en bloc excision of the lateral nasal wall and complete ipsilateral paranasal sinus mucosa removal remains the gold standard therapy due to IP's destructive potential, recurrence tendency, and association with malignancy.
• Less invasive approaches may be suitable for highly localized disease.