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Surgical treatment of inverted papilloma
Cengiz Durucu1, Tekin Baglam, Erkan Karatas
1Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Gaziantep University, Turkey
Insights
Inverted papilloma (IP) treatment varies by tumor stage. Endoscopic endonasal resection is effective for early-stage nasal tumors, while combined approaches reduce recurrence in advanced cases.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Oncology
Background:
- Inverted papilloma (IP) is a common benign tumor of the nose and paranasal sinuses, accounting for 0.5% to 4% of primary nasal tumors.
- Nasal obstruction is the most frequent symptom, affecting 89% of patients.
Purpose of the Study:
- To retrospectively review the surgical treatment outcomes for inverted papilloma (IP).
- To evaluate the recurrence rates associated with different surgical approaches for IP.
Main Methods:
- Retrospective evaluation of 68 patients with histopathologically confirmed IP.
- Exclusion of patients with concurrent squamous cell carcinoma.
- Analysis of surgical techniques including endoscopic endonasal resection, endoscopic endonasal resection with Caldwell-Luc, medial maxillectomy with lateral rhinotomy (LR), and endoscope-assisted medial maxillectomy with LR.
Main Results:
- Recurrence rates varied by surgical approach: medial maxillectomy with LR (28%), endoscopic endonasal resection (9%), endoscopic endonasal resection with Caldwell-Luc (7%), and endoscope-assisted medial maxillectomy with LR (8%).
- No major postoperative complications were reported.
- Tumor origin was most common in the maxillary sinus, lamina papyracea, and ethmoid sinus.
Conclusions:
- Inverted papilloma can be treated with both internal and external surgical approaches.
- Surgical approach selection should be based on tumor stage.
- Combined internal and external approaches demonstrate lower recurrence rates in advanced IP cases.
- Endoscopic endonasal resection is recommended for early-stage tumors.
Abstract:
Inverted papilloma (IP) is the most common benign tumor of the nose and the paranasal sinuses and constitutes almost 0.5% to 4% of the primary nasal tumors. In this study, our objective was to retrospectively review the results of surgical treatment of IP.Sixty-eight patients with a histopathologically proven diagnosis of IP were retrospectively evaluated. Two patients who had an associated squamous cell carcinoma were excluded from the study. Ten patients were operated on for revision surgery, and 56 eventually had a primary tumor. Patients operated on for primary tumor were included in this study. Nasal obstruction was the most frequent symptom observed in 50 patients (89%). The origin of the tumor was most common at the maxillary sinus, the lamina papyracea, and the ethmoid sinus. Endoscopic endonasal resection, endoscopic endonasal resection with the Caldwell-Luc procedure, medial maxillectomy after lateral rhinotomy (LR), and endoscope-assisted medial maxillectomy with LR approaches were used. The patients operated on only with medial maxillectomy after an LR procedure have a recurrence rate of 28% (2 patients). Endoscopic endonasal resection has a recurrence rate of 9% (2 patients). Recurrence observed after endoscopic endonasal resection with Caldwell-Luc procedures was 7% (1 patient). One recurrence (8%) was determined after an endoscope-assisted medial maxillectomy after LR. No major postoperative complications were observed after surgery.In conclusion, IP can be treated both with internal and external approaches. The type of surgery should be determined according to the tumor stage. Combined internal and external approaches have less recurrence rates in advanced cases. Endoscopic endonasal resection should be used in early-stage tumors.
