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  • Title: Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma.
    Author: Landsberg R, Cavel O, Segev Y, Khafif A, Fliss DM.
    Journal: Am J Rhinol; 2008; 22(6):629-34. PubMed ID: 19178804.
    Abstract:
    BACKGROUND: It is well documented that inverted papillomas (IP) have a localized attachment site. Still, instead of concentrating on the attachment site, endoscopic surgeons often perform an extended resection similar to the one achieved after external surgery. OBJECTIVE: Our objective was to evaluate an attachment-oriented endoscopic surgical strategy and to determine IP attachment diameter and location. METHODS: A prospective study was conducted. Thirty-three consecutive patients who underwent endoscopic IP excision (2001--2007) were enrolled. Thirty patients had adequate follow-up. Attachment diameters were measured in 25/33 patients. Surgery included debulking, identifying the precise mucosal attachment site, subperiosteal dissection and excision of the attachment, frozen section control, and resection/drilling of underlying bone. RESULTS: The mean measured attachment diameter (n = 25) was 8.4 +/- 6 mm (range, 3-23 mm). Attachment locations included maxillary sinus (39%), ethmoid sinus (21%), nasal cavity (21%), frontal sinus (6%), sphenoid sinus (6%), lamina papyracea (3%), and cribriform plate (3%). The mean follow-up (n = 30) was 40 +/- 21 months. Three patients had Krouse stage 1, 10 patients had stage 2, and 17 patients had stage 3. Nine patients had undergone previous surgeries. After attachment-oriented endoscopic surgery, three patients had persistent disease. Nasolacrimal duct stenosis was the only complication (n = 1). CONCLUSION: Even advanced IP have small attachments. Their Identification facilitates efficacious resection with minimal morbidity.
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