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Published on: January 17, 2018
Endoscopic Removal of Sinonasal Inverted Papilloma Originating From the Posterior Ethmoid Cavity
Sofia E Olsson1, René Peña1,2
1Department of Otolaryngology, Anne Burnett Marion School of Medicine, Texas Christian University, 2800 South University Dr, Fort Worth 76109, Texas, USA.
Abstract:
Sinonasal inverted papilloma is an expansive, benign mass derived from the Schneiderian membrane. It may undergo malignant transformation and most commonly originates from the maxillary sinuses or the lateral walls of the nasal corridors. This case outlines the case of a sinonasal inverted papilloma, which clearly arises from the posterior ethmoid sinus, bordering the skull base. This abnormal originating point was able to be identified during endoscopic excision of the mass and involved mucosa. The ethmoid bone was not resected as it would expose the dura mater, risking CSF leak and complications. This case further supports the use of endoscopy in the investigation of sinonasal inverted papilloma rather than the gold standard approach of lateral rhinotomy. An endoscopic approach allowed for improved safety when accessing the posterior ethmoid cavity. This case also highlights the possibility of novel origins of sinonasal inverted papilloma, such as the membrane of the posterior ethmoid cavity.
Insights
This study reports a rare case of sinonasal inverted papilloma originating from the posterior ethmoid sinus. Endoscopic surgery proved safe and effective for this unusual presentation.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pathology
Background:
- Sinonasal inverted papilloma (SNIP) is a benign neoplasm of the sinonasal tract, typically arising from the Schneiderian membrane.
- While commonly originating in the maxillary sinuses or lateral nasal walls, SNIP can undergo malignant transformation.
- Understanding diverse origins is crucial for effective management.
Observation:
- A case of SNIP originating from the posterior ethmoid sinus, adjacent to the skull base, is presented.
- Endoscopic excision identified the abnormal origin and involved mucosa.
- The ethmoid bone was preserved to avoid dural exposure and potential cerebrospinal fluid (CSF) leak.
Findings:
- The posterior ethmoid sinus represents a potential, albeit uncommon, site for SNIP.
- Endoscopic sinus surgery offers a safe and effective approach for accessing and excising SNIP in challenging locations.
- This approach avoids the risks associated with more invasive procedures like lateral rhinotomy.
Implications:
- This case expands the known anatomical origins of sinonasal inverted papilloma.
- It underscores the utility of endoscopic techniques for safely managing SNIP, particularly in skull base-adjacent regions.
- Further research into rare SNIP origins can refine surgical strategies and improve patient outcomes.
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