Clinical outcomes of sinonasal inverted papilloma surgery. A retrospective study of 67 cases.

BACKGROUND

Endoscopic sinus surgery has become popular for the management of sinonasal inverted papillomas (IP).

OBJECTIVE

The purpose of this report is to review our 13 years of experience in managing IPs.

METHODS

Retrospective chart study. Sixty-seven patients with sinonasal IPs were treated in our department from 1991 to 2004. Seventeen were managed using an endonasal non-endoscopic approach, 39 endoscopically, 8 through external techniques, and the remaining 3 using a combined approach.

RESULTS

After 1994, as we gained experience using endoscopic sinus surgery, most cases were treated endoscopically. In only 3 cases, where the tumour attachment site was in the lateral / anterior wall of the maxillary sinus and in the lateral wall of the frontal sinus, could the lesions not be accessed by extended endoscopic techniques, and an appropriate combination with external methods was required. The mean follow up period was 91 (range, 36-146) months. The recurrence rate was 59% using an endonasal non-endoscopic approach, 12.5% using an external incision, and 12.8% using endoscopic techniques. Average time to recurrence was 15 months.

CONCLUSION

Our findings suggest that endoscopic sinus surgery for sinonasal IP is a viable approach, with a low rate of recurrence and minor morbidity. Complete tumour resection at the site of attachment, including a surrounding rim of normal mucosa and drilling the underlying bone, is the key to successful treatment when it is combined with the preservation of healthy tissue. Non-endoscopic endonasal surgery is no longer a treatment option because the recurrence rate is too high.