Suction diathermy as an adjunct to endoscopic removal of inverted papilloma

Management of inverted papilloma: review

BACKGROUND

Inverted papilloma is the most common benign tumour affecting the nose. There is a high rate of recurrence and a potential of malignant transformation. This review article aimed to identify the best available management of this pathology today.

METHOD

A systematic review of the current English-language literature was performed. Only original articles with a minimum follow up of one year and an average follow up of two years were included.

RESULTS

A total of 1385 patients from 16 case series were identified. The total recurrence rate for all patients was 11.5 per cent. Significantly lower recurrence rates were found for procedures using an attachment-oriented excision (recurrence of 6.9 per cent; p = 0.0001) and utilising frozen sections (recurrence of 7.0 per cent; p = 0.0001).

CONCLUSION

There is a general trend towards endoscopic surgery. There may be some benefit to the use of attachment-oriented surgery and frozen sections. Multi-centred randomised controlled trials are required.

Challenges in the Management of Inverted Papilloma: A Review of 72 Revision Cases

OBJECTIVES/HYPOTHESIS

We report on the treatment outcome of endoscopically managed sinonasal inverted papilloma, focusing on revision cases. Our aim was to identify the properties of revision cases that affect treatment outcome by comparing them to primary cases in a single center. We propose using 5-fluorouracil (5-FU) in the postoperative management of inverted papilloma.

STUDY DESIGN

A retrospective single-center case series. This study met the criteria for approval by the local medical ethics committee.

METHODS

We performed a retrospective chart review identifying patients operated on between January 2003 and September 2013. Data were collected about patient demographics, symptoms, tumor attachment site, imaging, intraoperative and pathological findings, surgical approaches, postoperative treatment, follow-up, and recurrence.

RESULTS

One hundred and twenty-one (72 revision and 49 primary) cases were retrieved with a minimum follow-up of 1 year. Revision cases have significantly higher Krouse staging (P = 0.003), different distribution of tumor attachment sites, and higher recurrence rates. The recurrence rate was 4.1% for primary cases (mean follow-up 35.5 months) and 18.1% for revision cases (mean follow-up 45 months). Eight of the recurrent cases recurred within the first year. 5-fluorouracil was applied postoperatively in 18 (5 primary and 13 revision) cases, which included one (5.6%) recurrence and one minor complication (transient periorbital swelling).

CONCLUSION

The most important factors in preventing the recurrence of inverted papilloma are the determination of the location of the attachment and the completeness of resection in the primary endoscopic surgery. Revision cases have a higher recurrence rate, and the attachment sites are surgically more challenging. The use of 5-FU might have a place in the postoperative treatment of surgically challenging inverted papilloma.

LEVEL OF EVIDENCE

4.

Modified endoscopic maxillary medial sinusotomy for sinonasal inverted papilloma with attachment to the anterior medial wall of maxillary sinus

OBJECTIVES

The endoscopic management of inverted papilloma (IP) has gained in popularity over the last 15 years. However, the appropriate management of lesions involving the anterior medial wall of the maxillary sinus still has to be determined.

METHODS

We performed a retrospective review of the surgical results for patients with IP attached to the anterior medial wall of the maxillary sinus in the Otolaryngology, Head and Neck Surgery Department, Beijing TongRen Hospital. The tumors were removed by using our surgical technique of modified endoscopic maxillary medial sinusotomy, which was defined as an extended endoscopic medial maxillectomy with preservation of the nasolacrimal duct and inferior turbinate. Sinus endoscopy was used to screen for disease after endoscopic resection and the clinical outcomes were analyzed.

RESULTS

A total of 7 patients (4 males and 3 females) were identified. Pre- and postoperative pathological examinations revealed inverted papilloma as the diagnosis. All tumors were defined as Krouse III lesions. There were no complications recorded as a result of surgery. All patients remain disease free with a mean follow-up of 35.7 months (range 20-68 months).

CONCLUSION

Sinonasal IP with attachment to the anterior medial portion of the maxillary sinus can be treated successfully using modified endoscopic maxillary medial sinusotomy with preservation of the nasolacrimal duct and inferior turbinate.