A Study of Surgical Procedures for Inverted Papilloma in the Nasal Cavity and Paranasal Sinuses

Abstract

Inverted papilloma, although benign, recurs frequently and may become malignant, making definitive initial resection extremely important. We evaluated surgical procedures for recurrence and sites, with special reference to management of the orbital plate of the ethmoid and lacrimal bones, in 24 patients (32 cases) with inverted papilloma of the nasal cavity and paranasal sinuses undergoing surgical resection from 2000. Nine of the 32 showed recurrence, all around the ethmoid orbital plate. Up to 2002, recurrence was noted in 7 of 17 cases (41%), so we changed surgical selection criteria. Since 2003, we have conducted partial and combined excision of the orbital plate of the ethmoid and lacrimal bones (extended operation of the extranasal ethmoid and frontal sinuses) in cases in which tumors adhered to the orbital plate, noting recurrences in only 2 of 15 cases (13%). A number of reports advocate endoscopic sinus surgery to minimize invasiveness for inverted papilloma, but partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases to reduce recurrent.

Skull Base Inverted Papilloma: A Comprehensive Review

“…Controversy exists as to whether the bony undersurface of an IP should be removed [95]. Partial and combined excision of the orbital plate of the ethmoid and lacrimal bones (extended operation of the extranasal ethmoid and frontal sinuses) has been recommended in cases in which tumors adhered to the orbital plate [407]. Cases demonstrating atypia or dysplasia may be treated by the endoscopic route [2].…”

“…If maxillary sinus involvement in its anterior, inferior, superior, or lateral portion is suspected, a Caldwell-Luc approach is performed to allow for mucosal excision and complete removal of the anterior lateral nasal wall [485]. When the lamina papyracea or ceiling of the ethmoid or sphenoid sinus is involved, the bony wall is resected [407]. The frontal recess can be approached via a Lynch incision or an endoscopic transorbital approach.…”

“…It is an endoscopic approach that is gaining acceptance as an alternative to craniofacial or transfacial tumor resection [481, 488, 489]. Partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases, to reduce recurrence [407]. Chemotherapy and radiotherapy are added, depending on the type of tumor and its extent [407].…”

“…Partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases, to reduce recurrence [407]. Chemotherapy and radiotherapy are added, depending on the type of tumor and its extent [407]. In very carefully selected cases of malignant tumors ESS is oncologically acceptable, but more experience is needed for discerning the indications for endoscopic resection of malignant tumors [348, 490].…”

“…Although the lamina papyracea and lacrimal bones can be invaded and destroyed quite quickly, the periorbitum is a much better barrier to invasion. So despite bony destruction, if the periorbita is considered intact, they make the argument for orbital preservation and reconstruction [407]. Once the periorbital has been violated, orbital exenteration is required because few barriers to spread exist within the orbital contents.…”