DIFFERENT OPTIONS FOR TREATMENT OF INVERTING PAPILLOMA OF THE NOSE AND PARANASAL SINUSES - A REPORT OF 41 CASES

Forty-two cases of inverting papilloma of the nose and paranasal sinus es were reviewed from 1972 to 1989. Forty-one patients underwent surgi cal excision. Of those patients followed up for at least 6 months, lat eral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy , Caldwell-Luc operation, or intranasal approach. There were five pati ents (12%) diagnosed with squamous cell carcinoma associated with inve rting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on prese nting symptomatology is noted. Inverting papilloma is a benign neoplas tic lesion that shows variable aggressiveness. A computed tomography ( CT) scan evaluation is very important for the work-up. An aggressive w ide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and exte nsion of the lesion. A graduating approach from a lesser to a more maj or excision is advocated even though a risk exists of having to reoper ate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is esse ntial to eradicate disease in cases of recurrence. Close follow-up is necessary. Further surgery may be indicated. Post-operative radiation therapy is recommended if malignancy is indeed present.