Management of inverted papilloma of the nose and paranasal sinuses

Abstract

Inverted papilloma of the nose and paranasal sinuses is a neoplastic growth of epithelium which inverts into the underlying stroma rather than proliferating outward from the surface. These neoplasms probably arise from the area of the lateral nasal wall. Inverted papilloma is characterized by its: A. capacity to destroy; B. tendency to recur; and C. association with malignancy. During the past decade, we have come to understand better the histologic, biologic, and anatomic features of this tumor. More studies focusing on inverted papilloma have been published in recent years, and the authors of these reports have advocated more aggressive surgical procedures in the management of this tumor. The application of the technique of lateral rhinotomy and en bloc excision of the lateral nasal wall has dramatically decreased the recurrence rate while providing the patient with quite acceptable cosmetic and functional results. The surgical approach to inverted papilloma associated with squamous cell carcinoma varies with the extent of disease; but a good cure rate, especially with localized tumors, may be achieved with aggressive surgery combined with radiation therapy in these cases. We present a series of 19 patients with inverted papilloma. In 6 of these 19 patients, squamous cell carcinoma was associated with the inverted papilloma; 13 of the patients with inverted papilloma and 3 of the patients with an associated malignancy underwent lateral rhinotomy with en bloc excision of the lateral nasal wall. The tumor did not recur in these patients. The rationale for this surgery, as well as the details of these patient's case histories, form the basis of this report.