Sites of attachment of Schneiderian papilloma: a retrospective analysis

Inverted papilloma is a benign sinonasal tumor that arises from a localized attachment site. These attachment sites, however, have not been fully characterized in the literature. The objective of this research was to determine the specific distribution of attachment sites in patients with sinonasal papilloma.

Retrospective analysis of adult patients with sinonasal papilloma presenting to the University of Virginia between 1999 and 2010. These patients were reviewed and compared to historical controls with regard to histologic subtype and pedicle attachment site.

A total of 83 patients were identified with 90 sites of attachment. For inverted/cylindrical papilloma, sites of attachment included the maxillary sinus (42%), ethmoid sinus (18%), nasal cavity (15%), middle/superior turbinate (12%), frontal sinus (10%), sphenoid sinus (1.5%), and cribriform plate (1.5%). Specific attachment sites within each group were identified, including 5 at the infraorbital nerve. The distribution of attachment sites differed significantly from historical controls resected via an open approach (p = 0.001), but did not differ significantly from historical controls endoscopically resected (p = 0.696). A comparison of more specific sites of attachments could not be performed due to the lack of this information in the literature.

The distribution of attachment sites in patients with sinonasal papilloma has changed as the endoscope has enabled more detailed identification of pedicle attachment, which has implications for management.