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The inverted papilloma is primarily a benign, but locally aggressive epithelial tumor of the mucosal membrane of the nasal cavity and paranasal sinuses. It is characterized by a locally destructive growth, with the possibility of malignant transformation and a high tendency of recurrence at a low prevalence. The aim of this study was to analyze the clinical and histopathological characteristics and perioperative course of patients with inverted papilloma of the nasal cavity and paranasal sinuses.
The data of all patients with histologically proven inverted papillomas of the nasal cavity and paranasal sinuses, which underwent surgery at the Department of Otorhinolaryngology, UKGM Marburg from 01.01.2001 to 01.01.2014, were evaluated. 47 patients (35m/12f) with inverted papilloma of the nasal cavity and paranasal sinuses were included in the analysis.
The median age was 56 years (range: 15-91). The most characteristic symptom was an unilateral nasal obstruction (91.5%), the average time between onset of symptoms and histologically confirmed diagnosis was 3 months.
Computed tomography of the paranasal sinuses was the predominant diagnostic tool in the studied patient group (76.6%), followed by magnetic resonance imaging (38.3%) or cone beam computed tomography (10.6%).
45 patients showed an unilateral and 2 patients a bilateral manifestation of inverted papilloma. The left side (68%) was more frequently affected than the right side (32%). The main localization was the maxillary sinus (65.9%), followed by the ethmoid cells (53.2%) and the nasal cavity (31.9%). In regard to the Krouse classification of tumor extension 9 patients were staged T1, 4 patients were staged T2, 27 patients were staged T3 and 7 patients were assigned to the stage T4.
In 42 cases endoscopic endonasal surgery was performed, in 4 cases the patients were treated by an endo- and external approach and in one patient an external surgical access was performed. The tumor could be completely removed in all patients. The median duration of surgery was 105.2 minutes regardless of the T-Stage. In three patients the histological examination revealed a malignant transformation. In one of these patients a HPV-infection was detected.
42 patients (89.4%) were intraoperatively supplied with nasal packing. 5 patients (10.6%) with a stage T1 papilloma received no nasal packing. Postoperatively one patient showed a wound healing disorder (2.1%) and one patient suffered from postoperative hemorrhage (2.1%). One patient had an intraoperatively detected dural fistula, which was covered during the procedure.
12 patients developed a recurrence of the inverted papilloma. The highest recurrence rate was in the group with an initial T4 staged tumor.
In summary, endonasal endoscopic resection of inverted papilloma of the nasal cavity and paranasal sinuses is feasible in the vast majority of cases and appears to be associated with a low morbidity for the patients. A causal relationship with a possible HPV infection could not be detected in the studied population.
Due to the high recurrence rate and the possibility of malignant transformation regular follow-up examinations by an otolaryngologist should be performed after resection of an inverted papilloma.