Limited exposure with intranasal excision, high recurrence rates, and the 10% association with squamous cell carcinoma have been the arguments against endoscopic management of inverted papilloma. However, recurrence rates after medial maxillectomy, either through lateral rhinotomy or via a midface degloving range between 2% (Laryngoscope 104:582-605, 1994) to 30% (Otolaryngol Head Neck Surg 109:71-76, 1993). Improvements in our understanding of the pathogenesis and behavior of inverted papilloma have also fueled controversy over the necessity for open medial maxillectomy. For example, it is thought that recurrence of inverted papilloma is not only related to adequacy of resection, but to tumor biology, host susceptibility to new tumor formation, and operative seeding. This understanding along with technological advancements have stimulated renewed interest in minimally invasive treatment of inverted papilloma. Improvements in illumination, magnification, and angles of view, which an endoscope offers, are remarkable and are to be distinguished from technology used in traditional intranasal approaches. Enhancements in imaging techniques for the paranasal sinuses have helped refine surgical planning. Developments in surgical instrumentation, such as through cutting punches, soft tissue shavers, lasers, drills, and image guided surgery have improved our ability to expose and safely resect the locus of mucosal involvement. In this article, we describe our endoscopic evaluation, management, and postoperative surveillance of inverted papilloma. We review our results for the treatment of previously untreated and recurrent inverted papilloma involving the medial maxilla, ethmoid, sphenoid and the frontal recess. Our 6% recurrence rate of previously untreated inverted papilloma is consistent with results from open medial maxillectomy. Our early experience suggests that critics of an endoscopic approach have wrongly equated this approach with other intranasal approaches for management of inverted papilloma.
|Original language||English (US)|
|Number of pages||8|
|Journal||Operative Techniques in Otolaryngology - Head and Neck Surgery|
|State||Published - Jun 1 1999|
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