Abstract
Objective
Open, endoscopic and endoscopic-assisted surgical approaches to inverted papilloma (IP) have been described. 1) Assess the evolution of management within one institution with the largest case series and longest clinical follow-up of IP to date in the literature. 2) Compare this management with what has been recently presented in publication.
Methods
A retrospective review was performed of IP cases from 1973 to 2007, assessing gender, age, presenting symptoms, origin of lesion, staging, primary versus recurrence, radiographic findings, method of treatment, rate of recurrence, and associated malignancy. A comprehensive review of the literature was also performed.
Results
200 patients (average age, 57) underwent endoscopic or endoscopic-assisted resection of IP. Mean follow-up was 4.3 years (range 9 months −19 years). 80% of cases over the last decade had prior surgery before presentation. 63% were Krouse stage T3 and 25% were T4. Combined approaches were used for 57% of the most recent 40 cases, including Caldwell-Luc, lateral rhinotomy, medial maxillectomy, trephine, or osteoplastic flap. Rate of recurrence was 13% (range 8 to 144 months), with multiple recurrences after 2 years. The rate of malignancy was 7%.
Conclusions
IP can be safely addressed endoscopically when possible, with data from this study and the current literature suggesting this is feasible in 43–66% of cases. Variables affecting the decision to use adjuvant external approaches include significant scarring and anatomic distortion from previous surgery, high Krouse stage, and associated malignancy. Long-term follow-up is recommended. Emerging research on HPV will likely impact future management.
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