Currently, no generally accepted treatment for IP of the sinonasal area exists. Some authors prefer an endonasal micro-endoscopic removal , while others prefer a radical resection (Caldwell–Luc) that is similar to our treatment . The decision depends on the position, dimensions, stage, and recurrence of the tumor. Some authors believe that radical therapy of the IP in this area causes functional and aesthetic problems for the patient. Since very little data exist concerning the treatment and outcome for different treatments of IP in the sinonasal area, it is difficult to find the best solution for each patient. Because of the position of the tumor, radical resection was preferred in this case. Postoperative readjustment of the prosthesis was without functional constrictions. Our case shows that radical resection of tumors in this location does not necessarily imply serious functional and aesthetic impairment for the patient. It is notable that the reported relationship between IP and squamous cell carcinoma was observed in this case .
It is very important to correctly diagnose a tumor in its early stage to cure or treat the patient as soon as possible. A wrong diagnosis for IP has fatal consequences for patients. It must be decided from case to case which treatment is the best one for the patient. If a tumor is detected at an early stage and in an accessible location, endonasal micro-endoscopic surgery is a very elegant solution and can be done by any accordingly trained surgeon, mostly an otorhinolaryngologist. To achieve low recurrence rates of IP (and oncocytic papilloma), surgeons performing an endoscopic approach should consider drilling, cauterizing, or completely excising the bone underlying the tumor base instead of mucosal stripping alone . Whenever the location or stage of the tumor prohibits the endonasal technique, radical resection is the best option and it does not necessarily cause significant functional and aesthetic problems for the patient.
Currently, the treatment for IP is surgical but the type of surgical approach is still controversial. Endoscopic surgery has become the gold standard for the treatment of the vast majority of IP. Antral polypectomy with medial maxillectomy via a unilateral LeFort I osteotomy is much more aggressive than the other approaches but might be justified especially in higher stages of disease . There is a likely possibility of cutting through the tumor’s stalk and the oscillatory saw dispersing the tumor cells around the tumor site, which leads to a higher risk of recurrence. However, the risk of dispersal of tumor cells during surgery is also present during the other approaches. A well-done MRI and an expert surgeon can minimize these risks.
Another discussion is about the possible malignant transformation of IP. Some authors also recommend radiotherapy for advanced and/or recurrent papillomas . This of course can be performed in addition to surgery or even as the only treatment.
More studies have to be performed in order to analyze and record the recurrence rates and complications for different approaches [1, 8]. Today we recommend consideration of our approach in patients with advanced disease and/or a high risk for other tumors. As shown, it is not necessarily associated with any significant permanent restriction for the patient (Fig. 2).
In the light of the above-mentioned options and the different specialties possibly involved we strongly recommend treating IP within a multidisciplinary tumor board setting. Any treatment choice should only be made under consideration of the above-mentioned options of surgery (either endoscopic or open) and/or radiotherapy. In particular, an endoscopic surgeon needs to be “on board” since whatever treatment choice is made the endoscopic technique is always to be considered for at least preoperative biopsy and follow-up .