1. Endoscopic Resection of Maxillary Sinus Inverted Papilloma
Vincent Wu BHSc(H)1,2, Jennifer Siu MD3, Jonathan Yip MD3, John M. Lee MD FRCSC MSc2,3 1School of Medicine, Faculty of Health Sciences, Queen’s University; 2Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital; 3Division of Rhinology, Department of Otolaryngology – Head &Neck Surgery, St. Michael’s Hospital, University of Toronto
Background
Results
Results
Inverted papillomas (IP) most commonly develop in the maxillary sinus, particularly from the medial wall1,2
Maxillary sinus IPs have traditionally been resected via an endoscopic endonasal approach with adjunctive external procedures (ex. canine fossa and Caldwell-Luc approaches) when necessary2-4
The number and location of attachment sites for IP affects the surgical approach utilized5
Prognosis based on number of IP attachment sites within maxillary sinus has not been thoroughly identified in the literature
Figure 2: CT of Left Maxillary Sinus IP
Table 3: Wall of Maxillary Sinus Involved in Cases with Single Attachment
Posterior 1
Inferior
Lateral 2
Anterior
Medial 8
Superior
IPs with single attachment (46%) were predominantly to the medial walls
Hyperostosis along maxillary sinus floor is suggestive of IP attachment site
Table 4: Wall of Maxillary Sinus Involved in Cases with Multifocal Attachments
Posterior 7
Inferior
Lateral 9
Anterior
Medial 10
Superior 3
Figure 3: MRI of Left Maxillary Sinus IP
Figure 1: Maxillary Sinus IP – Pre-Operative and Post-Operative Imaging
IPs with multifocal (54%) attachments were predominately to the medial, lateral, and anterior walls
Table 5: Surgical Approaches
Medial Maxillectomy 28
Ethmoidectomy 23
Frontal Sinusotomy 10
Sphenoidotomy 4
Partial Middle Turbinate Resection 5
Septoplasty
DCR 2
T2 weighted MRI showing the convoluted cerebriform pattern of IP
Objective
Evaluate the effectiveness of a pure endoscopic approach for resecting IPs originating from the maxillary sinus
Method
All cases involved a medial maxillectomy to access to IP
Single-center, single-surgeon (JML) retrospective chart review
All maxillary sinus IP patients who underwent surgical resection from January 1, 2010 to June 30, 2016 were identified and included for analysis
Outcome measures: patient demographic, operative technique, IP sites of attachment, follow-up, and IP recurrence
Discussion
Despite the majority of patients having multiple maxillary IP attachment sites, all patients were managed with a pure endoscopic approach
Anterior and inferior wall IPs, often require combined approach due to difficult access, were managed only with an endoscopic medial maxillectomy in our series2
No difference in outcomes between single vs. multi-site IP attachments with regards to operative technique, LOS, recurrence, or intraoperative complications
Limitation: short follow-up duration of 18.9 months, since up to 20% of IP recurrence can occur 5 years after surgery6
Maxillary IPs with multifocal attachments most frequently involved 2-3 walls of the sinus
Table 2: Number of Walls Involved in Cases of Multifocal Attachment of IP
Number of walls involved
Number 1 2 5 3 4 6
Total 15
Results
Table 1: Patient Demographics
Total patient (n) 28
Gender (M:F)
17:11
Age, years (mean, SD)
54.9 (16.5)
Prev. recurrence (n, %)
10 (36%)
Recurrence (n, %)
0 (0.0%)
Malignancy (n, %)
1 (3.6%)
Follow up, months (mean, SD)
18.9 (13.9)
Length of stay, days (mean, SD)
0.68 (1.3)
Intraoperative complications (n)
IPs originating from the maxillary sinus frequently had multi-focal attachments
Two patients had multiple attachments to one wall
Conclusion
Despite surgical challenges of reaching all walls, maxillary IPs may be managed effectively via a pure endoscopic approach
References:
1. Buchwald C, Nielsen LH, Nielsen PL, Ahlgren P, Tos M. Inverted papilloma: a follow-up study including primarily unacknowledged cases. Am J Otolaryngol Aug;10(4):
2. Hong SL, Mun SJ, Cho KS, Roh HJ. Inverted papilloma of the maxillary sinus: Surgical approach and long-term results. Am J Rhinol Allergy Nov-Dec;29(6):441-4.
3. Krouse JH. Endoscopic treatment of inverted papilloma: safety and efficacy. Am J Otolaryngol. 2001 Apr;22(2):87-99
4. Hyams VJ. Papillomas of the nasal cavity and the paranasal sinuses, a clinicopathologic study of 315 cases. Ann Otol Rhinol Laryngol. 1971;80(2):192–6.
5. Yoon B, Batra PS, Citardi MJ, Roh H. Frontal sinus inverted papilloma: Surgical strategy based on the site of attachment. Am J Rhinol Allergy May;23(3):
6. Jiang XD, Dong QZ, Li SL, Huang TQ, Zhang NK. Endoscopic surgery of a sinonasal inverted papilloma: Surgical strategy, follow-up, and recurrence rate. Am J Rhinol Allergy Jan 1;31(1):51-55.