Different options for treatment of inverting papilloma of the nose and paranasal sinuses: a report of 41 cases.

Forty-two cases of inverting papilloma of the nose and paranasal sinuses were reviewed from 1972 to 1989. Forty-one patients underwent surgical excision. Of those patients followed up for at least 6 months, lateral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy, Caldwell-Luc operation, or intranasal approach. There were five patients (12%) diagnosed with squamous cell carcinoma associated with inverting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on presenting symptomatology is noted. Inverting papilloma is a benign neoplastic lesion that shows variable aggressiveness. A computed tomography (CT) scan evaluation is very important for the work-up. An aggressive wide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and extension of the lesion. A graduating approach from a lesser to a more major excision is advocated even though a risk exists of having to reoperate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is essential to eradicate disease in cases of recurrence. Close follow-up is necessary. Further surgery may be indicated. Post-operative radiation therapy is recommended if malignancy is indeed present.

Conservative medical management of traumatic pharyngoesophageal perforations.

Traditionally, surgical treatment has been the acceptable management for perforation of the pharyngoesophageal tract secondary to blunt and penetrating trauma. From July 1983 to June 1990, we managed 10 patients with this type of lesion by a conservative medical management approach. Mirror or fiberoptic flexible laryngoscopy was performed in the majority of cases to ascertain the nature of the injury. An esophagogram is very helpful to locate and evaluate the extent of the injury. All patients were treated with broad-spectrum intravenous antibiotic therapy and no oral feeding. There were no complications or need for surgical treatment in any of the cases. The head and neck surgeon, in selected cases, should consider the possibility of using conservative management of pharyngoesophageal perforations. This approach has proven in our hands to be relatively safe and cost-effective, resulting in no disability or prolonged hospitalization of our patients. This study involves two institutions (two affiliated hospitals of Case Western Reserve University School of Medicine) with different surgeons selecting appropriate antibiotic therapy. It is a retrospective review. No controls were made by random selection of cases treated surgically. These cases, if not properly managed, may lead to fatal outcomes.