Clinical Analysis of Sinonasal Inverted Papilloma according to Surgical Approach

Roh, Hwan Jung; Kim, Ki Tae; Lee, Hyun Sun; Lee, Sang Joon; Chon, Kyong Myong

Abstract

BACKGROUND AND OBJECTIVES
This study was designed to compare the clinical outcomes according to surgical approach of extranasal, endonasal endoscopic, and a combined approach of the two, suggesting the indication of each surgical approach for excision of sinonasal inverted papilloma (IP). SUBJECTS AND METHOD: Fifty-six IP patients who had been operated at the department of Otorhinolaryngology, Pusan National University Hospital from January, 1995 to March, 2001 were retrospectively assessed. The patients were arbitrarily divided into three groups such as excision through extranasal approach (EEA), endonasal endoscopic excision (EEE), and EEE combined with Caldwell-Luc's approach (EEE+C-L) group. RESULTS: The most commonly affected sites by CT/MRI preoperatively was the nasal cavity followed in the decreasing order of frequency by maxillary, ethmoid, sphenoid, and frontal sinus. In the EEA group, the originated sites were the nasal cavity (2/6), maxillary (1/6), and frontal sinus (2/6). In the EEE group, the origin sites by operative findings were the nasal cavity (30/41), maxillary (5/41), sphenoid (3/41), and ethmoid (2/41) sinus. In the EEE+C-L group, eight cases (8/9) originated from the maxillary sinus. There were six cases associated with malignant tumors, five synchronous and one metachronous, treated combined with radiotherapy and/or chemotherapy. A total of eight cases recurred during the follow-up period. The recurrence rate was 16.6% (1/6) in EEA, 14.6% (6/41) in EEE and 10.1% (1/9) in EEE+C-L group, and there was no significant difference according to surgical approaches. CONCLUSION: EEE yielded a successful outcome only when the IP was limited to the originating sites of nasal cavity, medial and upper wall of maxillary sinus, ethmoid sinus, and sphenoid sinus. The complete removal of the tumor by EEE alone could not be achieved when the tumor was originated from the anterior, inferior, and posterolateral wall of maxillary sinus, requiring application of C-L's approach at the same time. EEA can be used with more benefits than EEE when the tumor is originated from the frontal sinus or when the mass tends to invade extensively.