Inverting papilloma of the head and neck: The UCLA update

Abstract

Inverting papilloma of the nose and paranasal sinuses is a benign disease with malignant potential. This disease is characterized by multiple recurrences, especially after minimal operative therapy. Controversy exists over the most appropriate treatment for this rare tumor. This review presents an update of the UCLA experience with inverting papilloma over the past four decades along with a review of the literature. A retrospective study of 61 patients seen at the UCLA Medical Center was conducted. The mean age at presentation was 63 years, with a male-to-female ratio of 2:1. The most common symptom at presentation was nasal obstruction (71%), followed by epistaxis (27%). Seventeen percent of the patients in this series either had concurrent squamous cell carcinoma of the nose or paranasal sinuses, or it developed. Patients treated with a lateral rhinotomy and medial maxillectomy had a recurrence rate of 30 percent. Those treated with a less aggressive operation had a recurrence rate of 71 percent. Despite a trend for a more conservative sinus operation in recent literature, we continue to advocate a lateral rhinotomy and medial maxillectomy as the treatment of choice for inverting papilloma of the head and neck.

Treatment outcomes of primary and recurrent inverted papilloma: an analysis of 96 cases

“…The recurrence rate of inverted papilloma without malignancy depends on the extent and type of operation. The recurrence rate, after medial maxillectomy, ranged from 0 per cent to 30 per cent, 8 and after conservative resection, ranged from 10 per cent 12 to 74 per cent 8 in other reports. In our series, the recurrence rate of inverted papilloma without malignancy was 33.9 per cent with conservative resection, and 14.3 per cent with medial maxillectomy.…”

Schneiderian Papillomas and Nonsalivary Glandular Neoplasms of the Head and Neck

“…Although reported to be bilateral in 0 -10% of cases, such an occurrence should always arouse the suspicion of septal erosion and perforation from unilateral disease (2,3,15,24,29).…”

“…Inverted papillomas (IP) are two to five times more common in males and are found primarily in the 40 -70-year age group (2,3,8,14,15,(23)(24)(25)(26)(27)(28)(29)(30). The 6-year-old boy included in the series of Eavey (31) is one of the youngest patients yet described with this papilloma.…”

Bilateral inverted papilloma: A report of two cases and review of the current literature

“…It is more common in men and usually presents in the fifth and sixth decades of life [10]. Unilateral disease and unilateral nasal obstruction is the most common presenting feature [11,12] but, as demonstrated in this article, bilateral disease does occur with reported rates of 2-7% [1,6,7]. The etiology of this multicentric appearance has yet to be fully understood.…”

“…Traditional teaching has been to treat inverted papilloma with aggressive surgery in the form of a lateral rhinotomy and medial maxillectomy in an effort to limit recurrence [11,12,17,18]. However, over the last decade many reports have emerged using endoscopic techniques [9,[19][20][21][22] with rates of recurrence averaging out at 13.4%.…”