SINONASAL SCHNEIDERIAN PAPILLOMA

Objective: Schneiderian papilloma of the paranasal sinuses is a locall y aggressive benign epithelial tumour with malignant potential. Method : A retrospective analysis of 72 patients as seen at our institution f rom 1978 to 1997 was conducted. Results: The most frequent symptoms at time of presentation were nasal obstruction, presence of a nasal mass , and nasal discharge. The most common sites of involvement were the m axillary antrum (58.3%), lateral nasal wall (41.7%) and ethmoid sinus (37.5%). Histologic examination confirmed all 72 instances of schneide rian papilloma, with 55/72 (76.4%) being of the inverted type, 13/72 ( 18.1%) being the fungiform type, and 4/72 (5.5%) being the cylindrical type. An associated malignancy or potential premalignant condition wa s present in 15 patients (20.8%), with 8 (11.1%) exhibiting dysplastic changes, 4 patients (5.5%) found to have carcinoma in situ, and 3 pat ients (4.2%) found to have invasive carcinoma. Conservative surgical e xcision was performed in 37 (51.4%) with more radical surgery, includi ng lateral rhinotomy and medial maxillectomy performed in 35 (48.6%) p atients. Recurrence was seen in 17/37 (45.9%) patients treated conserv atively compared to 0/35 (0.0%) patients treated aggressively. Conclus ions: Our results indicate that more aggressive surgery is associated with a more definitive treatment and significantly less recurrence and , as such, is the management of choice in cases of schneiderian papill oma. Furthermore, our results indicate the need for long-term follow-u p, and the applicability of sinus endoscopy in doing so.