Inverted papilloma of the maxillary sinus: a case for Caldwell-Luc

Background Inverted papilloma (IP) is a benign tumor of the sinonasal cavity. Due to its carcinomatous potential, risk for local destruction and high rate of recurrence, its complete surgical resection has always been the standard treatment. The Caldwell-Luc (CL) procedure has been the gold standard for surgery of the maxillary sinus over the past century. Despite its efficacy, less radical endoscopic techniques have replaced this classical approach for most indications over the last decades by treating IP with low recurrence rates and less morbidity. However the IP of the maxillary sinus could be difficult to fully visualize and remove especially in case of lateral, inferior or anterior maxillary wall involvement. The aim of this case report is to show that the more radical CL procedure can still be rational for specific indications even today.

Methods We present the case of a 75-year old man with an IP of the right maxillary sinus and a history of many recurrences after endoscopic surgical tumor removals. The CT revealed the tumor on the floor and anterior wall of the right maxillary sinus. This location could not be adequately reached endoscopically even with angled endoscopes. We opted therefore for a CL approach.

Results We managed to entirely resect the IP with the CL transmaxillary method. We completed the procedure by smoothing the anterior wall of the maxillary sinus.

Conclusions Depending on the tumor extension and attachment sites, an endoscopic approach alone can be insufficient for the IP removal and an external or combined external/endoscopic procedure should be considered. Since the CL technique has proven to be safe and efficient in the past and it can still be relevant for certain indications, it should not be excluded from the surgical practice.

Publication History

Article published online:
19 April 2024