Management of Inverted Papilloma of the Temporal Bone

Abstract

Objective: 1) Understand the clinical presentation, etiology, and histopathology of inverted papilloma of the temporal bone. 2) Discuss current treatment and management of inverted papilloma of the temporal bone as well as considerations for future management.

Method: Inverted papilloma (IP), a benign neoplasm typically arising within the sinonasal tract, has rarely been reported occurring outside the sinonasal tract. Only 18 cases of temporal bone IP have been reported. We review our 2 cases of temporal bone IP and discuss their management.

Results: Our cases demonstrate both primary and secondary temporal bone involvement. The first case was a primary lesion with atypical otoscopic appearance of a granular mass extending from the middle ear through a tympanic membrane perforation. This was managed with a tympanoplasty, canal wall up mastoidectomy, and facial recess approach. The second case presented as a subepithelial mass extending from the posterior wall of the ear canal after 3 resections of a sinonasal IP. Because of advanced bone destruction, extensive resection similar to a retrolabyrinthine approach was required, followed by tympanomastoid obliteration. Recurrence was monitored with baseline and follow-up PET-CT scans.

Conclusion: Temporal bone IP is a rare neoplasm with no definitive treatment algorithm. We recommend aggressive surgical resection with close postoperative follow-up. PET-CT may be useful for identifying multicentric disease at presentation or for early identification of recurrent disease. HPV detection may identify IPs at risk for multicentric or recurrent disease.