SURGICAL TREATMENT FOR INVERTED PAPILLOMA OF NASAL CAVITY , ENDOSCOPIC OR OPEN APPROACH : OUR EXPERIENCE

Abstract

Objective: The main aim of this study is to share our experience in treating sinonasal inverted papillomas, particularly those treated by endoscopic approach.

Materials and methods: This retrospective study wa sconducted at Ganeshman Singh Memorial Academy of ENT-HNS Studies, Maharajgunj Medical Campus, Institute of Medicine (IOM), Tribhuwan University Teaching Hospital (TUTH) between 18th October 2011 to 17th July 2015. A total of 40 patients were enrolled in the study. All patients underwent contrast enhanced computerized tomography (CT) scan of nose and paranasl sinuses followed by punch biopsy to confirm the diagnosis. All patients underwent medial maxillectomy either endoscopiccally or via lateral rhinotomy approach. Patients were followed up regularly at monthly interval for first 6 month thereafter 3 monthly for the 2 years.

Results: Among 40 patients 23 were female and 17 were male with female to male radio being 1.4:1. Maximum age was 74 years and minimum age 17 years. The most common symptom was unilateral nasal obstruction with blood mixed nasal discharge in all patients, Right side was involved in 17 (42.%) patients and left was involved in 23 (57.5%) patients. In all cases the tumour arised from lateral nasal wall (100%). Maxillary sinus epicenter was seen in 75% (30 cases) and followed by ethmoid sinus 25% (10 cases). Endoscopic medial maxillectomy performed in most case 26 (65%) whereas external lateral rhinotomy plus medial maxillectomy was done in 14 (35%). Recurrence was seen in 4 cases of open medial maxillectomy and 3 cases of endoscopic medial maxillectomy and all of which was managed with endoscopic ecxision. The overall recurrence rate was 17.5% (endoscopic medial maxillectomy 11.5% and lateral rhinotomy plus medial maxillectomy 28.5%)

Conclusion: Although (IP) is rare intermediate tumour of nasal cavty, its recurrence is high. Its treatment is always surgical. Endoscopic medial maxillectomy is the surgery of choice for treating majority of inverted papilloma. The lateral rhinotomy with medial maxillectomy is limited to extensive cases.

Keywords: Inverted papilloma, Lateral rhinotomy, Medial maxillectomy