European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 7, pp 1953–1959 | Cite as

Endoscopic and combined external–transnasal endoscopic approach for the treatment of inverted papilloma: analysis of 110 cases

  • Vittorio Sciarretta
  • Ignacio Javier Fernandez
  • Paolo Farneti
  • Ernesto Pasquini


The aim of the study was to evaluate the effectiveness of the endoscopic approach for the management of inverted papilloma (IP) of the nose and paranasal sinuses and the possible factors associated with its recurrence. One hundred and forty-one patients affected by an IP originating at the level of the sinonasal tract were treated surgically using an endoscopic technique alone or a combined external–endoscopic approach at the ENT Department of the University of Bologna between January 1994 and December 2012. Of these patients, 110 were selected for the recurrence analysis. Univariate and multivariate analyses were performed to detect risk factors for IP recurrence. The patients had a mean follow-up of 56.7 months (24–167 months). Seven cases (6.3 %) of recurrence were observed in patients treated with the endoscopic approach for the primary or recurrent tumor. Previous surgery (p = 0.005) and number of previous surgical procedures (p = 0.003) were associated with higher recurrence rate. The number of previous operations was associated to recurrence-free survival at Cox regression analysis. In our study, the endoscopic approach showed itself to be a useful tool for the radical resection of an IP. The endoscopic approach should be tailored for the different extensions of IP. Recurrent cases showed an increased risk of further recurrence. Therefore, these should be treated paying particular attention to the boundaries of the primary tumor.


Inverted papilloma Endoscopic surgery Nasal endoscopy Nasal tumors 


  1. 1.
    Krouse JH (2001) Endoscopic treatment of inverted papilloma: safety and efficacy. Am J Otolaryngol 22(2):87–99PubMedCrossRefGoogle Scholar
  2. 2.
    Sukenik MA, Casiano R (2000) Endoscopic medial maxillectomy for inverted papillomas of the paranasal sinuses: value of the intraoperative endoscopic examination. Laryngoscope 110:39–42PubMedCrossRefGoogle Scholar
  3. 3.
    Waitz G, Wigand ME (1992) Results of endoscopic sinus surgery for the treatment of inverted papillomas. Laryngoscope 102:917–922PubMedCrossRefGoogle Scholar
  4. 4.
    Klimek T, Atai E, Schubert M et al (2000) Inverted papilloma of the nasal cavity and paranasal sinuses: clinical data, surgical strategy and recurrence rates. Acta Otolaryngol 120:267–272PubMedCrossRefGoogle Scholar
  5. 5.
    Stankiewicz JA, Girgis S (1993) Endoscopic surgical treatment of nasal and paranasal sinus inverted papilloma. Otolaryngol Head Neck Surg 109(6):988–995PubMedGoogle Scholar
  6. 6.
    Kamel RH (1995) Transnasal endoscopic medial maxillectomy in inverted papilloma. Laryngoscope 105:847–853PubMedCrossRefGoogle Scholar
  7. 7.
    Lund VJ (2000) Optimum management of inverted papilloma. J Laryngol Otol 114:194–197PubMedGoogle Scholar
  8. 8.
    Tufano RP, Thaler ER, Lanza DC et al (1999) Endoscopic management of sinonasal inverted papilloma. Am J Rhinol 13(6):423–426PubMedCrossRefGoogle Scholar
  9. 9.
    Schlosser RJ, Mason JC, Gross WC (2001) Aggressive endoscopic resection of inverted papilloma: an update. Otolaryngol Head Neck Surg 125:49–53PubMedCrossRefGoogle Scholar
  10. 10.
    Han JK, Smith TL, Loehrl T et al (2001) An evolution in the management of sinonasal inverting papilloma. Laryngoscope 111:1395–1400PubMedCrossRefGoogle Scholar
  11. 11.
    Pasquini E, Sciarretta V, Farneti G et al (2004) Inverted papilloma: report of 89 cases. Am J Otolaryngol 25(3):178–185PubMedCrossRefGoogle Scholar
  12. 12.
    Lee TJ, Huang SF, Lee LA et al (2004) Endoscopic surgery for recurrent inverted papilloma. Laryngoscope 114(1):106–112PubMedCrossRefGoogle Scholar
  13. 13.
    Kraft M, Simmen D, Kaufmann T et al (2003) Long-term results of endonasal sinus surgery in sinonasal papillomas. Laryngoscope 113(9):1541–1547PubMedCrossRefGoogle Scholar
  14. 14.
    Sadeghi N, Al-Dhahri S, Manoukian JJ (2003) Transnasal endoscopic medial maxillectomy for inverting papilloma. Laryngoscope 113(4):749–753PubMedCrossRefGoogle Scholar
  15. 15.
    Kaza S, Capasso R, Casiano RR (2003) Endoscopic resection of inverted papilloma: University of Miami experience. Am J Rhinol 17(4):185–190PubMedGoogle Scholar
  16. 16.
    Tomenzoli D, Castelnuovo P, Pagella F et al (2004) Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients. Laryngoscope 114(2):193–200PubMedCrossRefGoogle Scholar
  17. 17.
    Lawson W, Patel ZM (2009) The evolution of management for inverted papilloma: an analysis of 200 cases. Otolaryngol Head Neck Surg 140(3):330–335PubMedCrossRefGoogle Scholar
  18. 18.
    Landsberg R, Cavel O, Segev Y, Khafif A, Fliss DM (2008) Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma. Am J Rhinol 22(6):629–634PubMedCrossRefGoogle Scholar
  19. 19.
    Minovi A, Kollert M, Draf W, Bockmühl U (2006) Inverted papilloma: feasibility of endonasal surgery and long-term results of 87 cases. Rhinology 44(3):205–210PubMedGoogle Scholar
  20. 20.
    Walgama E, Ahn C, Batra PS (2012) Surgical management of sinus inverted papilloma: a systematic review. Laryngoscope 122(6):1205–1209PubMedCrossRefGoogle Scholar
  21. 21.
    Yoon BN, Batra PS, Citardi MJ, Roh HJ (2009) Frontal sinus inverted papilloma: surgical strategy based on the site of attachment. Am J Rhinol Allergy 23(3):337–341PubMedCrossRefGoogle Scholar
  22. 22.
    Anari S, Carrie S (2010) Sinonasal inverted papilloma: narrative review. J Laryngol Otol 124(7):705–715PubMedCrossRefGoogle Scholar
  23. 23.
    Lombardi D, Tomenzoli D, Buttà L, Bizzoni A, Farina D, Sberze F, Karligkiotis A, Castelnuovo P, Nicolai P (2011) Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: a reassessment after 212 cases. Head Neck 33(8):1154–1161PubMedCrossRefGoogle Scholar
  24. 24.
    Sham CL, Woo JK, van Hasselt CA, Tong MC (2009) Treatment results of sinonasal inverted papilloma: an 18-year study. Am J Rhinol Allergy 23(2):203–211PubMedCrossRefGoogle Scholar
  25. 25.
    Skolnick EM, Loewy A, Friedman JE (1966) Inverted papilloma of the nasal cavity. Arch Otolaryngol 84:83–89Google Scholar
  26. 26.
    Schwab W, Schmeisser KJ, Steinhoff HJ et al (1985) Instructions for the documentation of neoplasms in the area of the head and neck following the TNM system. Contribution to the validation of the TNM system. HNO 33(8):337–348PubMedGoogle Scholar
  27. 27.
    Krouse JH (2000) Development of a staging system for inverted papilloma. Laryngoscope 110:965–968PubMedCrossRefGoogle Scholar
  28. 28.
    Oikawa K, Furuta Y, Oridate N et al (2003) Preoperative staging of sinonasal inverted papilloma by magnetic resonance imaging. Laryngoscope 113(11):1983–1987PubMedCrossRefGoogle Scholar
  29. 29.
    Dragonetti A, Gera R, Sciuto A, Scotti A, Bigoni A, Barbaro E, Minni A (2011) Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification. Rhinology 49:207–213PubMedGoogle Scholar
  30. 30.
    Weber R, Draf W, Kratzsch B et al (2001) Modern concepts of frontal sinus surgery. Laryngoscope 111(1):137–146PubMedCrossRefGoogle Scholar
  31. 31.
    Stennert E (2001) Rhino-frontal sinuseptotomy (RFS): a combined intra-extra nasal approach for the surgical treatment of severely diseased frontal sinuses. Laryngoscope 111(7):1237–1245PubMedCrossRefGoogle Scholar
  32. 32.
    Vural E, Suen JY, Hanna E (1999) Intracranial extension of inverted papilloma: an unusual and potentially fatal complication. Head Neck 21(8):703–706PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Vittorio Sciarretta
    • 1
  • Ignacio Javier Fernandez
    • 2
  • Paolo Farneti
    • 1
  • Ernesto Pasquini
    • 3
  1. 1.ENT DepartmentUniversity of Bologna, Ospedale Sant’Orsola-MalpighiBolognaItaly
  2. 2.ENT DepartmentAzienda Ospedaliera Santa Maria degli AngeliPordenoneItaly
  3. 3.ENT DepartmentAzienda USL di BolognaBolognaItaly

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