Endoscopic surgical treatment of nasal and paranasal sinus inverted papilloma

Most of the papers written in the past regarding surgical treatment of nasal and sinus inverted papilloma recommend aggressive surgical treatment-usually a medical maxillectomy with external or transantral ethmoidectomy. However, since the introduction of endoscopic diagnostic and surgical techniques for the treatment of nasal and sinus disease, the treatment of inverted papilloma requires review. In Europe, Waitz and Wigand1 and Draf* routinely treat inverted papilloma endoscopically, reserving extensive surgery for papilloma involving the maxillary sinus or for recurrent disease. Fifteen cases of inverted papilloma of the nose and paranasal sinuses are discussed in this article. Ten cases represent inverted papilloma treated primarily with endoscopic sinus surgery; five were endoscopically treated for secondary or recurrent disease. All primarily treated patients had disease limited to the nose, nasal cavity, ethmoid, sphenoid, or medial wall of the maxillary sinus. The one patient in whom a recurrence in the maxillary sinus developed laterally underwent a medial maxillectomy for control. All patients treated endoscopically have had their disease followed for a minimum of 1 year, with an average of 3 years. Four patients in this study had traditional surgery involving medial maxillectomy and ethmoidectomy for an initial diagnosis of inverted papilloma. These patients manifested recurrent papilloma into the sphenoid sinus bilaterally in one case, frontal sinus in another, and the maxillary sinuses in two other cases, and all patients have papilloma controlled endoscopically. Endoscopic nasal and sinus diagnosis and surgery is appropriate for diagnosis, followup, and treatment of both limited and recurrent inverted papilloma, provided all patients are made aware of the possibility of recurrent and need for more extensive surgery as a result.(ABSTRACT TRUNCATED AT 250 WORDS)