Management of Maxillary Sinus Inverted Papilloma via Transnasal Endoscopic Anterior and Medial Maxillectomy

Abstract

Objective: To introduce and evaluate the effectiveness and safety of transnasal endoscopic anterior and medial maxillectomy (TEAMM) in the treatment of Krouse stage III inverted papilloma (IP) originating from the maxillary sinus. Methods: A retrospective chart review was performed for 33 patients with Krouse stage III IP undergoing TEAMM in our hospital between 2003 and 2008. Results: Tumors were completely resected through TEAMM. Sixteen cases had type I TEAMM, during which the nasolacrimal duct was preserved; 17 had type II TEAMM, during which the nasolacrimal duct was resected. The inferior turbinate was partially preserved in 26 cases. Patients were followed for a mean of 40.4 months. Recurrence developed in 2 patients, dry nose syndrome in 5 patients, and epiphora in 1 patient. Squamous cell carcinoma occurred in 1 patient. Conclusions: TEAMM is an effective and safe technique in the management of Krouse stage III IP and provides good exposure of operative cavities during follow-up.

Sinonasal Inverted Papilloma and the Dilemma of Treatments

“…3 Second is its destructive expansion and third is the tendency for malignant transformation reaching to 21% mostly SCC. 1,5,7 The introduction of endoscopes and their wide use in nasal surgery has changed the view of management of inverted papilloma and their technological advancements, including improved optics, angled endoscopes and computer-aided navigation has led many surgeons practicing them nowadays instead of the traditional open technique. [5][6][7]10 At the beginning endoscopes were used combined with the open approach but soon endoscopic surgery was the surgery of choice as their advantages were supported by many studies in the literature.…”

“…It accounts for 0.5 to 4% of all primary nasal tumors. 1 It exhibits a strong male predominance and usually occurs between 50 and 69 years. The World Health Organization subdivides sinonasal papilloma into three histological types: inverted papilloma, cylindrical (columnar) papilloma and exophytic papilloma (fungiform).…”

“…[5][6][7] Classically, the tumor originates from the lateral nasal wall, particularly in the osteomeatal complex area of the middle meatus, and adjacent inferior and middle turbinates, and subsequently involves the contiguous paranasal sinuses, with the maxillary sinus as the most frequent sinuss involved and ethmoid sinus as the second most common. 1,5,7 Unilateral nasal obstruction and intermittent epistaxis are the most common presenting symptoms. 5-8…”

Management of Sinonasal Inverted Papillomas and Clinic Outcomes

“…8,9 Maksiller sinüste medial, posterior veya inferior bölge tutulumu gösteren tümörlerde, transnazal endoskopik medial maksillektomi uygulanabilir. 10 Maksiller sinüs anterior ve lateral bölge tutulumu gösteren tümörlerde ise endoskopik cerrahi ve Caldwell-Luc yaklaşımı birlikte uygulanmalıdır. 7 Lateral rinotomi, pnömatizasyonu iyi olan maksiller sinüsün lateral reses bölgesinde veya nazolakrimal bölgede tutulumu olan tümör-lerde uygulanabilen bir yaklaşımdır.…”

Advances in recurrence and malignant transformation of sinonasal inverted papillomas

“…In addition, the Korean multicenter study suggested that surgeons should consider combined approaches to reduce recurrence for advanced SIP [Krouse staging system: T3 stage (12); Furuta staging system: T3-A stage (13); Cannady staging system: group B (14)], particularly for novice surgeons (2). Although certain authors propose that SIP involving attachment sites within the maxillary sinus require a endoscopic-external combined technique (1,26), emerging evidence suggests that novel tailored ESS techniques (endoscopic modified medial maxillectomy, and transnasal endoscopic anterior and medial maxillectomy) allow enhanced visualization and preserve important structures, including the inferior turbinate and nasolacrimal duct (27)(28)(29). However, other authors proposed that the endoscopic-external combined approach remains essential for recurrent maxillary SIP (30).…”