Inverted Papilloma of the Sinonasal Cavity: The Surgical Strategy of Endoscopic Management Based on the Site of Attachment

ABSTRACT

The refinement of the endoscopic techniques and development of sophisticated surgical instrumentation has lead to a progressive evolution from external to endoscopic approaches for management of sinonasal inverted papilloma (IP). The golden rule for endoscopic surgery of IP involving the sinonasal cavity is complete resection of the tumor, especially complete extirpation of the tumor attachment or origin area. Preoperative radiologic images using by computed tomography and magnetic resonance could not afford exact information of tumor attachment. Only intraoperative endoscopic findings can provide the precise tumor attachment in the sinonasal cavity. The surgical strategy should be focused on the tumor attachment so that the approach should be different based on the site of attachment in each sinus. And the approach should be minimally invasive fashion. Endoscopic surgery has strong advantage in cases with IP originating from the ethmoid and sphenoid sinus compared to "headlight" surgery era. Integrated approach could be applied in cases with IP originating from the frontal and maxillary sinus.