Inverted Papilloma Management

Abstract Introduction Inverted papilloma (IP) remains a serious challenge in ENT practice. Inverted papilloma is a benign but locally aggressive nasal tumor originating from the lateral nasal wall with high recurrence rate and potential for malignant transformation. The aim of the study is to analyze the alternative approaches, techniques and results in the management of IP.

Material and methods A group of 16 patients all males with an average age of 42,6 years, range 35 – 66 years were treated with IP. The diagnosis was based on typical signs and symptoms, nasal endoscopy, CT scan, MRI and biopsy with histopathology. The radical surgery was performed in the subperiosteal plane to assure complete removal with free histological margins. Treatment of inverted papilloma is surgical: simple polypectomy (2 cases); endonasal endoscopic surgery (3 cases); combined endoscopic sinus surgery with external approach via canine fossa (6 cases); Caldwell – Luc procedure (3 cases), and medial maxillectomy (2 cases).

Results The postoperative control included nasal endoscopy and imaging study at 3, 6 and 12 months after surgery. Recurrence rate 12,5 % (2 cases) was after simple polypectomy with inadequate removal tumor, or unrecognized residual disease. No recurrence was observed after radical surgery. The follow-up period ranged from 6 months to 10 years (mean 4,8 years).

Conclusions The extent and localization of disease dictated the feasibility of different surgical approaches and procedures. The therapeutic management of this aggressive tumor included endoscopic surgery, combined endoscopic procedures or external approaches in order to ensure excellent long – term results.

Keywords inverted papilloma (IP), endoscopic surgery, external approaches

Publication History

Article published online:
10 June 2020