Sinonasal inverted papilloma from diagnosis to treatment - a narrative review

Abstract

Inverted papilloma (IP) is a non-cancerous tumor that develops from the paranasal sinuses. Identifying and diagnosing an IP is vital for an ear, nose and throat specialist, due to its high recurrence rate and ability to transform into malignant carcinoma. Diagnosis is based on endonasal flexible endoscopy, preoperative biopsy, and imaging methods. Treatment is exclusively surgical, and its aim is the complete resection of the tumor to prevent further recurrences. The success of surgery depends on employing the most appropriate surgical technique. The choice should be tailored to the tumor's location, size, and the patient's specific anatomy. Endoscopic, open, or even combined approaches may be considered. Notably, attachment-oriented surgery is the cornerstone in endoscopic endonasal approaches. Regardless of the chosen approach, long-term surveillance is vital, as early detection provides the benefit of easier re-resection.

Keywords: endoscopic endonasal surgery; paranasal sinus neoplasms; sinonasal inverted papilloma.

Figure 1

Histopathological aspect of inverted papilloma. Hematoxylin–Eosin (HE) staining, ×100

Figure 2

Endoscopic view of the left nasal fossa presenting a papillomatous-looking tumor at this level (Personal collection of Dr. Mihail Tuşaliu, 2022)

Figure 3

CT scan without contrast agent of the sinonasal region, in axial plane, highlighting the presence of a papillomatous tumor in the left nasal fossa and left maxillary sinus (Personal collection of Dr. Mihail Tuşaliu, 2022). CT: Computed tomography

Figure 4

CT scan without contrast agent of the sinonasal region, in axial plane, showing an area of hyperostosis at the anterior wall of the right maxillary sinus: the point of origin of the inverted papilloma (Personal collection of Dr. Mihail Tuşaliu, 2021)

Figure 5

Endoscopic aspect of the left nasal fossa revealing an inverted papilloma for which piece-meal resection is performed, aiming to identify its origin (Personal collection of Dr. Mihail Tuşaliu, 2022)

Figure 6

Ablation of the inverted papilloma at the insertion area: the postero-medial wall of the left maxillary sinus, with removal of the tumor, mucosa and drilling of the underlying bone (Personal collection of Dr. Mihail Tuşaliu, 2022).

Figure 7

Figure 8

Caldwell–Luc approach for complete ablation of the inverted papilloma originating from the anterior and lateral wall of the right maxillary sinus (Personal collection of Dr. Mihail Tuşaliu, 2021)

Figure 9

Endoscopic view of the sphenoid sinus with complete removal of the papillomatous tumor originating from the left sphenoidal wall (Personal collection of Dr. Mihail Tuşaliu, 2017)

Figure 10

Endoscopic left sphenoidal image using a 70°-angled rod, visualizing the origin of the inverted papilloma at the lateral sphenoidal wall, adjacent to the left opticocarotid recess (Personal collection of Dr. Mihail Tuşaliu, 2017)