The Experience Of Endoscopic Sinus Surgery For Sinonasal Inverted Papilloma

Sinonasal inverted papilloma is a relatively uncommon benign epit- helial tumor constituting 0.5%–4%. All nasal tumours.arise typically from the lateral nasal wall or within the maxillary sinus.Males are 4–5 times more frequently affected than females.NIP is prevalent in the fifth and sixth decades of life.The four characteristic attributes of Inverted papilloma are its tendency to recur, its destructive capacity, the associated nasal polyps, and its propensity to be associated with malignancy. The main treatment is surgery.The best surgical approach and the extent of resection are somewhat controversial, as is discussed in the literature.The approaches include conservative intranasal piecemeal excision,Caldwell-Luc surgeries and a more aggressive wide excision by lateral rhinotomy. The above procedure has a high recurrence rate and facial scars. With the development of nasal endoscopy and imaging diagnostic techniques ,completely resection endos- copic nasal and sinus inverted papilloma becomes possible.Endoscopic sinus surgery for nasal inverted papilloma is characterized by a less trauma and the function of nasal cavity and paranasal sinuses were better retained.Endoscopic resection is a favorable treatment option for most cases of sinonasal inverted papilloma.Objective:To investigate the surgical methods and the recurrence rate of NIP undergoing endoscopic sinus surgery.Materials and methods:A retrospective analysis was performed of medical records for 21 cases treated with endoscopic resection of inverted papilloma at the Department Otolaryngology Head and Neck Surgery of Dalian Medical University Second Hospital from September 2006 to September 2008. All patients received standard endoscopic sinus surgery.There were 16 males and 5 females in the study group,resulting in a male to female ratio of 3.2:1. The patient ages ranged from 23 to 75 years, with an average age of 51.6 years. In 9 patients, tumor was located on the left side and in 12 patients on the right side.All patients underwent CT. On the basis of clinical and radiological findings, all patients were classified according to the staging systems separately reported by Krouse specifically for NIP. The staging of tumor was summarized as follows:10 pts in I,9 pts in II; 2 pts inⅢand 0 pts inⅣ.All patients was treated by endoscopic sinus surgery. The follow-up time was ranged from 6 to 30 months. All patients were examined with nasal endoscope.Results:All the 21 cases of inverted papillomas were removed completely and no serious complications occurred.The follow-up time was ranged from 6 to 30 months showed that 3 cases of tumor recurrence (14.2%).Of the 3 cases, ethmoid sinuses were involved in 2 cases, and maxillary sinus was involved in 1 case.In cases of tumor recurrence, revision surgery was carried out, following up no recurrence.Conclusion:Endoscopic sinus surgery is an excellent procedure for treating NIP who have limited disease that involves the lateral nasal wall, the anterior and posterior ethimoid sinuses, and the medial maxillary wall(KrouseⅠ,Ⅱand parts ofⅢ). It can completely remove the tumor and the nasal function can be retained.