Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma - first experiences

Purpose: Surgical excision is generally regarded as the treatment of choice for inverted papilloma. However, the approach and extent of surgery has be en subject of much debate. The purpose of this study is to evaluate the res ults of endoscopic sinus surgery in the treatment of paranasal sinus invert ed papilloma. Patients and Methods: Thirteen cases of inverted papilloma of the paranasal sinuses treated via endoscopic sinus surgery were evaluated. The follow-up averaged from 9 months to 48 months with a mean of 27 months. Results: A close follow-up of all patients was maintained. Seventy-seven pe r cent (10/13) of the patients had no recurrence after the initial endoscop ic procedure. Three patients had recurrences of their tumor within 11 month s after surgery, which means a rate of 23% (3/13). In 2 patients, the recur rences were treated endoscopically. In one patient, recurrence and malignan t transformation (squamous cell carcinoma) developed after 36 months, which means that the associated carcinoma rate was 7% (1/13). This patient under went radical maxillectomy and postoperative radiotherapy. None of the patie nts died of inverted papilloma. Conclusion: Endoscopic sinus surgery is a viable treatment alternative for Paranasal sinus inverted papilloma in selected cases. This approach should be performed by experienced surgeons and a close follow-up is mandatory. Wh en the disease is more extensive, it should be approached by radical surger y, e.g. en-bloc excision by medial maxillectomy via lateral rhinotomy or mi d-facial degloving.