Sinonasal inverted papilloma: Recurrence, surgical management, and mini review

Abstract

Objective: Sinonasal inverted papilloma (SIP) has a high rate of recurrence and a potential to be transformed into a malignant disease, hence surgery is the treatment of choice. In this study, we aimed to identify the preoperative features of patients diagnosed with SIP and discuss treatment options, recurrence rates, and postoperative clinical outcomes.

Methods: Twenty-six patients who were diagnosed with SIP between 2010 and 2014 in a training and research hospital were included in the study. Their charts were reviewed retrospectively. The complaints at admission, findings of anterior rhinoscopy, nasal endoscopy, and radiological examinations were recorded along with histopathological features. Different surgical treatment modalities and recurrence rates were analyzed regarding tumor characteristics and postoperative outcome.

Results: The average postoperative follow-up was 32.1 +/- 20 months. According to Krouse classification, 15 (57.7%) patients were staged as T3, eight (30.8%) were T2, and three (11.5%) were T1. Endoscopic sinus surgery was performed in 21 patients. Medial maxillectomy via lateral rhinotomy (classical technique) was performed in five patients. Two patients (7.7%) who had endoscopic surgery had a recurrence of SIP; however, the rate was not statistically significant when compared with that of patients who underwent the classical technique. Histopathological examination revealed chronic rhinosinusitis with nasal polyposis (19.2%), squamous metaplasia (3.8%), and squamous cell carcinoma (7.7%) concurrent with SIP.

Conclusion: Endoscopic surgery should be the first choice for the treatment of SIP. It may be combined with classical methods in some patients with advanced stage disease, especially when the tumor spreads to areas that are difficult to reach. Following surgical intervention, the patients should be followed carefully to identify recurrence or malignant transformation as early as possible.