Endoscopic 532-nm KTP Laser Excision of Inverted Papilloma of the Nose and Paranasal Sinuses: A Series of 9 Patients

Abstract

Over the past 2 decades, the surgical management of inverted papillomas has evolved from extensive radical excision to more conservative surgery. We conducted a study to evaluate the results of our endoscopic approach to tumor excision with the 532-nm potassium titanyl phosphate (KTP-532) laser. Ourseries included9patients with inverted papillomaofthe nose and paranasal sinuses who were treated from January 1998 through December 2003 (72 mojo Only 1 patient (11.1%) experienced a recurrence. The recurrence was detected 12 months after initial treatment, and it was successfully managed via the same endoscopic approach; afterward, the patient was still tumor-free at 2.5 years offollow-up. The good results of this endoscopic approach for lesions limited to the nose and paranasal sinuses canbeattributed to excellent visualization with theendoscope and to the bloodless dissection achieved with theKTP-532 laser. Weemphasize the need for frequent and long-term follow-up of these patients;a thorough endoscopic examinationat everyvisit is extremely important.

Sinonasal Inverted Papilloma and the Dilemma of Treatments

“…4 The cause behind the use of these aggressive approaches is related to the characteristics of the inverted papilloma. 6 First the ability of the tumor to recur is highly variable and was reported to be 0 to 86% 1,5-7,10 even after free period up to 7 years 7 or more in some studies. 3 Second is its destructive expansion and third is the tendency for malignant transformation reaching to 21% mostly SCC.…”

“…1,5,7 The introduction of endoscopes and their wide use in nasal surgery has changed the view of management of inverted papilloma and their technological advancements, including improved optics, angled endoscopes and computer-aided navigation has led many surgeons practicing them nowadays instead of the traditional open technique. [5][6][7]10 At the beginning endoscopes were used combined with the open approach but soon endoscopic surgery was the surgery of choice as their advantages were supported by many studies in the literature. 2,7,[11][12][13][14] Endoscopic surgery has complications as the open approach but occurring in lower rates.…”

“…1,10 They are associated with lower recurrence rates. 6,7,15 Endoscopes can be used as adjunct to open approach in selected cases. 2,7 Many studies had been conducted regarding the introduction of different substances in order to decrease the recurrence rate, incidence of malignant transformation and the need for other surgery.…”

“…The authors' believe that for inverted papilloma limited to nose and paranasal sinuses their approach is a good option in view of the low rates of recurrence and the minimal postoperative morbidity. 6 Mitomycin-c is another modality of adjunct therapy that was studied. Malcolm Woodcock et al used 0.02% mitomycin C (MMC) in recurrent inverted papilloma of the lacrimal sac.…”

“…6 The unique characteristics of inverted papilloma are its tendency to recur, its destructive expansion into the surrounding structures and its potential for malignant transformation mainly squamous cell carcinoma (SCC) which occur in about 5 to 21% of the cases. [5][6][7] Classically, the tumor originates from the lateral nasal wall, particularly in the osteomeatal complex area of the middle meatus, and adjacent inferior and middle turbinates, and subsequently involves the contiguous paranasal sinuses, with the maxillary sinus as the most frequent sinuss involved and ethmoid sinus as the second most common. 1,5,7 Unilateral nasal obstruction and intermittent epistaxis are the most common presenting symptoms.…”