Different endoscopic strategies in the management of recurrent sinonasal inverted papilloma

Sinonasal inverted papilloma (IP) is noted for its high rate of recurrence. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for IP, only a few published reports have studied the efficacy of endoscopic surgery for recurrent IP, and the surgical approach has been the subject of much debate. In this study, our objective was to demonstrate the effectiveness and limitations of 3 different endoscopic procedures used for the treatment of recurrent IP. From January 2001 to June 2008, 26 patients with recurrent IP were treated with endoscopic surgery. Previous surgeries included 5 cases of lateral rhinotomy and 21 cases of endoscopic endonasal surgery. With preoperative computed tomography or magnetic resonance imaging, we attempted to identify the sites of origin and attachment of IP. Three types of resection were used: basically, purely endoscopic endonasal resection was used for tumors arising from lateral nasal wall, ethmoid sinus, and frontal sinus; endoscope-assisted medial maxillectomy was used for tumors originating from the medial wall of the maxillary sinus; and the combination of the endoscopic and Caldwell-Luc procedure was used for tumors involving the anterior, inferior, superior, or lateral portion of the maxillary sinus. Efficacy was evaluated strictly by endoscopic examination or computed tomography in a mean follow-up of 28.2 months (range, 13-42 mo). Three types of procedure were performed in 6, 10, and 10 patients, respectively. Three patients had residual recurrence within 2 months after the resection. One tumor was confirmed malignant. There were no major complications encountered in the patients. In conclusion, different endoscopic strategies are modulated in relation to the attachment of recurrent tumor. The purely endoscopic endonasal procedure is suited for the treatment of recurrent IP limited to the nasal cavity, the ethmoid sinus, and the frontal sinus. As to tumors arising from the maxillary sinus, medial maxillectomy or an additional Caldwell-Luc surgery should be performed.