Inverted Papilloma of the Maxillary Sinus: A Recurrence Analysis According to Surgical Approaches

Abstract

(1) Background: Various surgical approaches have been introduced to resect inverted papillomas (IP) stemming from the maxillary sinus (MS). This study aimed to compare the recurrence rates of IPs originating from the MS according to various surgical modalities. (2) Methods: A total of 155 surgical cases of sinonasal IPs originating from the MS were categorized into three groups according to the surgical approach adopted: endoscopic resection via middle or inferior meatus antrostomy (ESS), ESS with Caldwell−Luc approach or canine fossa trephination (ESS with CL), and expanded endoscopic approaches (ExEA) including endoscopic medial maxillectomy or a prelacrimal recess approach. A Kaplan−Meier curve was generated to examine the recurrence rates. (3) Results: The overall recurrence rate was 5.8% (9/155) with a mean follow-up period of 24.2 months. The recurrence rates for the ESS, ESS with CL, and ExEA groups were 10.0% (7/70), 3.5% (2/57), and 0% (0/28), respectively. The ExEA group had a significantly lower recurrence rate than the ESS group (p = 0.024) and there was a tendency for lower recurrence compared to the ESS within the CL group (p = 0.145). The ExEA required a shorter postoperative hospitalization period than in ESS with CL (p < 0.001). (4) Conclusions: ExEAs to the maxillary sinus such as the PLR and EMM approaches are excellent surgical options for IPs originating from the MS.

Keywords: inverted; maxillary sinus; papilloma; paranasal sinuses.

Figure 1

Modified endoscopic medial maxillectomy approach with preservation of the inferior turbinate. (A) Lacrimal duct has been resected. The inferior turbinate is pedicled posteriorly providing a wide access to the left maxillary sinus. (B) After complete removal of the inverted papilloma, the inferior turbinate is repositioned. (C) Postoperative 1-year endoscopic view of the left nasal cavity with well-preserved inferior turbinate. IT—inferior turbinate; NLD—nasolacrimal duct.

Figure 2

Prelacrimal recess approach in a patient with an inverted papilloma in the right maxillary sinus. (A) Curved incision from the lateral wall of the nasal cavity to the nasal floor. The arrows indicate inverted papilloma. (B) Bony pyriform aperture, lateral wall, anterior end of the IT, inferior meatus, and nasal floor are identified. (C) Prelacrimal bone osteotomy. (D) The NLD is easily identified while medializing the bony lateral wall of the nasal cavity. (E) The lateral wall flap consisting of the NLD and IT is tented medially, exposing the medial wall of the MS. (F) The bony medial wall of the MS is removed, and the mucosa incised. (G,H) The tumor in the MS is debulked, isolating the attachment site. (I) Multilayer centripetal resection with 1 cm margins. (J) Drilling the hyperostotic attachment site. (K) Wide MMA. (L) Repositioning the lateral wall flap. IT—inferior turbinate; MMA—middle meatal antrostomy; MS, maxillary sinus; NLD, nasolacrimal duct.

Figure 3

Kaplan–Meier plot according to surgical approach. There were nine recurrences in total: ESS, 10.0% (7/70); ESS with CL, 3.5% (2/57); and EAA, 0% (0/18). There was a significant difference in recurrence rate between the three groups (p = 0.004, log-rank test). The ExEA group had a lower recurrence rate than the ESS group at 74.2 months after the surgery (p = 0.024, fixed time-point survival test). ExEA—expanded endoscopic approach; ESS—endoscopic resection via middle meatal antrostomy and/or inferior meatal antrostomy; ESS with CL—ESS with the Caldwell–Luc approach or canine fossa trephination.

Figure 4

Kaplan–Meier plot for primary and revision cases. There were seven and two recurrences in primary and revision cases, respectively. There was no significant difference in recurrence rates between the two groups (p = 0.600, log-rank test).

Figure 5

Kaplan–Meier plot for the subgroup analysis of primary cases. There were seven recurrences among the primary cases: ESS, 10.2% (6/59); ESS with CL, 3.0% (1/33); and ExEA, 0% (0/25). There were significant differences in recurrence rates between the three groups (p = 0.010, log-rank test). The ExEA group had a lower recurrence rate than the ESS group at 74.2 months after surgery (p = 0.035, fixed time-point survival test). ExEA—expanded endoscopic approach; ESS—endoscopic resection via middle meatal antrostomy and/or inferior meatal antrostomy; ESS with CL—ESS with the Caldwell–Luc approach or canine fossa trephination.