M. Winter et al., Inverted papilloma of the nose and the paranasal sinuses. Longterm resultsafter endoscopic endonasal sinus surgery, HNO, 48(8), 2000, pp. 568-572
There is still some skepticism about endoscopic endonasal resection of inve
rted papillomas. We conducted a long-term retrospective study and examined
104 patients (82 male, 22 female) with inverted papilloma who were operated
at the ENT-Department of the University of Erlangen between 1974 and 1997.
The endoscopic approach was chosen in each case, either alone or in combin
ation with external approaches. In 64.4% (67 cases), tumors of all T-classe
s were resected by endoscopic approach alone (T1:17.9%,T2:23.9%,T3:41.8%,T4
:16.4% For the rest of the patients an additional transoral and transfacial
approach was necessary due to difficult tumor localization (T2:24.3%,T3:29
.7%, T4:45.9%). The mean age of the patients was 55 years. The recurrence r
ate after primary endoscopic endonasal sinus surgery was 22.4% (15/67) and
after combined endoscopic and external surgery 16.2% (6/37). Second salvage
surgery after endoscopic sinus surgery was performed again endonasally in
46% (7/15) and externally in 53.3% (8/15). The recurrence rate after the en
donasal approach was now 57.1% (4/7) and 50% (4/8) after external surgery.
Third salvage surgery was performed again endoscopically in four cases and
externally in four cases. The recurrence rate in both groups was 50% each,
so that up to six operations, either endoscopically or externally, were nec
essary for complete tumor resection. The longest period for a tumor recurre
nce was 3.4 years after endoscopic sinus surgery and 9 years after combined
endoscopic and external surgery. A tumor recurrence after endoscopic endon
asal sinus surgery that could not be managed endoscopically again occurred
in 12%. Tumor localization is the limiting factor for endoscopic endonasal
sinus surgery of inverted papilloma. However, in 64.4% of cases, endoscopic
endonasal sinus surgery alone was performed successfully without any loss
of one patient. Long-term follow-up is necessary since the recurrence of tu
mor can happen after a long time. Endoscopic endonasal sinus surgery of inv
erted papilloma is safe and should be preferred due to its minimal invasive
character.