Sinonasal Inverted Papilloma: Efficacy of Demucosation to Reduce Recurrence After Surgical Managements

Abstract

To compare the outcomes of various surgical approaches to resect sinonasal inverted papilloma and to discuss their advantages and disadvantages. A retrospective chart review of 61 consecutive patients with sinonasal inverted papilloma was performed. Surgical treatment included non-demucosation endoscopic sinus surgery (ESS), demucosation ESS, endonasal medial maxillectomy (EMM), Draf type 3, Caldwell-Luc surgery, Denker, Killian, and lateral rhinotomy. Recurrence rates were compared between endonasal and external approaches and between demucosation and non-demucosation. After the first curative surgery, the non-demucosation ESS, endonasal demucosation (demucosation ESS, EMM, and Draf type 3), and external surgery showed recurrence rates of 61.5%, (8/13), 0.0% (0/21), and 7.4% (2/27), respectively. A significantly lower recurrence rate was observed in the endonasal demucosation (p < 0.001) and in the demucosation ESS group (p < 0.001) in comparison with the non-demucosation ESS. However, as for recurrence rate, no statistically significant difference was observed between endonasal surgery and external surgery (p = 0.162). Demucosation is a better strategy for the treatment of inverted papilloma than is non-demucosation. Demucosation is the key procedure for preventing recurrence.

Keywords: Endonasal approach; External approach; Inverted papilloma; Krouse staging.

Fig. 1

Krouse staging. a T1. Coronal CT image demonstrates the tumor arising from the middle nasal turbinate in the right nasal cavity. b T2. Coronal CT image show the tumor in the left ethmoid sinus, slightly invading medial wall of the left maxillary sinus. c T3. Coronal CT image show the tumor of the right maxillary sinus with the hyperostosis on the surface of the maxillary sinus

Fig. 2

Therapeutic strategy

Fig. 3

Differential diagnosis between inverted papilloma and sinusitis. A-63-year woman with left maxillary inverted papilloma (T3). Axial CT image a and axial T1-weighted MRI b show a mass in the left nasal cavity and maxillary sinus, with a slight lesion in the right maxillary sinus. Axial T2-weighted MRI demonstrates an intermediate-to-slightly high signal intensity mass (arrow) indicating inverted papilloma. The high signal intensity area on the ipsilateral (left) side (asterisk) suggests obstructed secretion or secondary inflammatory mucosa in the maxillary sinus. The high signal intensity area (arrow head) on the contralateral (right) maxillary sinus indicates inflammatory mucosa