Isolated Inverting Papilloma Of The Sphenoid Sinus

Objectives:Primary inverting papilloma of the sphenoid sinus is rare.We present two cases of inverting papilloma with isolated involvement of the sphenoid sinus and discuss the incidence,histological findings,clinical presentation,radiographic features, nasal endoscopic examination,and management of patients with this disease.Study Design:Case series and review of the pertinent literature.Methods:To analyse the cases and literature,and then to summarize the clinical presentation,radiographic features,nasal endoscopic examination and treatment of this disease.Results:In case 1,the patient manifests with occipital headaches,retro-orbital pain, mucopurulent nasal discharge,and orbital apex syndrome,which is typical clinical manifestations.In case 2,the patient with transient ischemic attacks(TIA) of the vertebro-basilar system,had no common symptoms,but right facial numbness.It was not clear whether inverting papilloma of the sphenoid sinus associated with TIA or facial numbness.In these two cases,the radiographic features were typical and common. CT showed a slightly higher density in sphenoid sinus,especially in case 1,showed bony erosion and focal hyperostosis.MRI showed hypodense to isodense on T1-weighted images and isodense to hyperdense on T2-weighted images.The mass slightly enhances with contrast and appears nonhomogeneous with surrounding hyperdense.Nasal endoscopy showed a unilateral tumor near the natural sphenoid ostium.Diagnostic nasal endoscopy procedures and imaging techniques are of great value for an early and precise diagnosis,and might facilitate preoperative prediction of tumor origin.In case 1,the patient underwent endoscopic subtotal resection,while in case 2 underwent endoscopic total resection,both were followed near 6 months.But the origin sites were not definite in these two cases.There was no recurrence in case 2.In case 1 the patient with symptoms gradually improved,needs further treatment.Conclusion:The clinical presentation of inverting papillomas confined to the sphenoid sinus is often nonspecific and insidious,radiographic features is significant for diagnosis,and might facilitate treatment.endoscopic intranasal sphenoidotomy remains an effective mode of treatment for patients with these lesions.The successful result of endonasal surgery depends on precise and complete local resection of the tumor followed by complete removal of the mucoperiostium by drilling the underlying bone.Considering the vital location of the sphenoid sinus and surrounding structures, staged resection combined with naviganonal system is likely to actualize,if necessary. Radiotherapy as adjuvant therapy has been applied.Because of its high recurrence rate, long-term follow-up is needed.