Endoscopic Endonasal Removal of Advanced Sinonasal Inverted Papilloma

Abstract

Objectives:

(1) Demonstrate our endonasal procedure to totally remove advanced sinonasal inverted papilloma (SIP). (2) Show the successful outcome in the long-term follow-up study.

Methods:

A retrospective study. Forty-six sides of the 45 patients with SIP were operated on for the last 13 years. Nineteen of the 45 patients showing advanced stage (III:17 and IV:2 in Krouse’s staging) were enrolled in this study. They consisted of 11 men and 8 women, and the age ranged from 28 to 92 years old. Endoscopic endonasal sinus surgery with aid of supplementary techniques described below was performed in all patients.

Results:

Extranasal methods were not required in this study. Transinferior turbinate approach to the anterior part of the maxillary sinus was applied to 5 of the 11 patients where SIP originated from the maxillary sinus. Endonasal medial maxillectomy was added to 2 of the 5 patients because of the inferior turbinate invasion. Draf type IIb or III procedure was applied to 4 of the 5 patients in whom the frontal sinus was involved. In 2 patients who showed the sphenoid sinus invasion, transseptal approach was used. During the 15 to 122 months follow-up period, recurrence was seen in 2 patients in whom simple ESS procedure had been performed in the maxillary sinus.

Conclusions:

Our endonasal removal procedure for advanced SIP is acceptable, and may be alternative to extranasal methods, although longer follow-up study is required.