Management of sinonasal inverted papilloma: our experience

Aim. Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. This study describes the surgical experience of 32 patients with IP of paranasal sinuses treated at our institution , and it recurrence rate after (at least) a year of follow-up. Methods. A retrospective chart review was performed on patients presenting with IP of paranasal sinuses. Patient charts were reviewed for age, extent of tumor, location(s), follow-up, surgery technique and histopathologic diagnosis. 32 patients comprised the focus of this study. For all patients it was performed a pre-surgery TC, and for 5 more patients it was necessary to perform a Magnetic Resonance (MR) with gadolinium. Results. Twenty-one open surgeries, 9 endoscopic approach and 4 combined approach (open and endoscopic) were performed for IPs, with a minimum of 1 years’ follow-up. Our results highlighted that the global percentage of success 12 months after the treatment was 93% and it did not vary according to the tipology of approach used if a radical escission of the lesion is achieved. More in depth, among 32 cases, only 2 patients were found to have recurrences and were treated with coronal and endoscopic approach. Conclusion. It is fundamental to underline that surgery must be carried on in a radical manner to treat these neoplasms that tend to recur. The ideal approach is frequently determined intraoperatively, based on the IP attachment sites. A complete removal of the lesion and bone peripheral border filing are essential to perform a correct and definitive treatment. Also, endoscopic approach can be taken into account when tumors are localised median to a sagittal plan crossing the orbit median wall and when they did not massively compromised paranasal sinus walls.