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Rhinology/Allergy

(467) Surgical Managements of Sinonasal Inverted Papilloma

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Naruo Shoji, MD

    Director
    Tachikawa Minami-guchi ENT clinic
    Shibasaki-cho, Tachikawa, Tokyo, Japan

    • Co-Author(s)

  • Yasuyuki Hinohira, MD

    Section Chief
    Kamio Memorial Hospital
    Chiyoda, Tokyo, Japan

  • YN

    Yoichiro Narikawa, MD

    Ph.D. student
    Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University.
    Shinagawa, Tokyo, Japan

  • Masakazu Murayama, MD

    Ph. D. student
    Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University.
    Shinagawa-ku, Tokyo, Japan

  • SK

    Sei Kobayashi, Prof.

    Associate professor
    Department of Otorhinolaryngology, Showa university Fujigaoka Hospital.
    Yokohama, Kanagawa, Japan

  • ST

    Syunsuke Takamatsu, MD

    Takamatsu ENT clinic, USA

Disclosure(s):
Naruo Shoji, MD: No relevant relationships to disclose.
Yasuyuki Hinohira, MD: No relevant relationships to disclose.
Yoichiro Narikawa, MD: No relevant relationships to disclose.
Masakazu Murayama, MD: No relevant relationships to disclose.
Sei Kobayashi, Prof.: No relevant relationships to disclose.


Introduction: Inverted papilloma (IP) is the most frequent benign tumors in the sinonasal region, and may involves malignant lesion. In recent years, endoscopic sinus surgery (ESS) has become increasingly popular in the surgical treatment of IP, and this study presents our experience and results of endoscopic surgery in our IP cases.

Methods: 27 sinonasal IP cases operated on by one surgeon between 2016 and 2019 were enrolled in this retrospective study. They consisted of 18 males and 9 females, and the mean age was 61.2 years old. IP was diagnosed by biopsy before surgery in 20 cases (77.8%). They were classified into T1: 4, T2: 10, and T3: 13 cases according to Krouse staging.
ESS was performed in all T1 cases. In addition to ESS, endoscopic modified medial maxillectomy was performed in 9 cases in T2 and T3 cases. Extended frontal sinus surgery was added in 5 T3 cases. External nasal surgery was required in 3 T3 cases.
All cases were periodically followed up more than 2 years after surgery.

Results: Recurrence was seen in 3 T3 cases, and the recurrent region was the roof of the ethmoid sinus, the frontal recess, and the medial wall of the orbit. The cause of recurrence seems to be residue due to severe adhesion between the stalk of IP and the bone. No malignant transformation was seen.

Conclusions: Total resection of IP using ESS was completed in T1 and T2 cases. T3 cases still have possibility of recurrence even if external nasal surgery was performed. In order to prevent recurrence, it is necessary to make a reliable diagnosis before surgery and to resect the stalk of IP completely during surgery.