Novel Technique For Management Of Inverted Papilloma Of Frontal Sinus

According to new research, large sinus tumors can be removed through the nose using endoscopy rather than having to make large incisions in the face.

With this approach, doctors use tiny scopes and cameras to enter the nose and remove the tumor with a device that pulverizes and suctions. At points where the tumor adheres to the sinus lining, the lining is removed and a diamond drill is used to eliminate tumor cells in the underlying bone.

In the study, which appears in the September/October issue of the American Journal of Rhinology, researchers performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004.

Researchers used endoscopy to remove large inverted papillomas in 18 people, aged 36 to 74, and found this method worked well in these patients.

Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection or open/endoscopic approach for isolated frontal sinus involvement.. Of the 5 patients who had their disease managed endoscopically, 3 patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach.

One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures.

Endoscopy was also useful in checking for the re-growth of the tumors, which have a high rate of recurrence.

All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. The authors stress that operative risk and postoperative morbidity are significantly less than with open procedures. Recurrences are more frequent, but are detected early and are easily resected with minimally invasive techniques. Open procedures involve large facial incisions and potential complications, including eye loss, cerebral spinal fluid leaks, and disfigurement.

In the present study, the recurrence rate among the endoscopy patients was 50 %, compared with the usual recurrence rate of 44 % among patients who have open procedures.

The authors conclude that the limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. They claim that success of initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus.