Surgical management of inverted papilloma involving the frontal sinus: a practical algorithm for treatment planning

Abstract

SUMMARY Inverted papilloma of the frontal sinus is a challenging disease. Given its rarity, only small case series are present in the literature. The objectives of the present study are to review our experience in the surgical management of inverted papillomas involving the frontal sinus and to propose a practical algorithm for selecting the most appropriate approach. Data on patients affected by inverted papilloma involving the frontal sinus and surgically treated between 2002 and 2016 were collected. The type of involvement of frontal sinus and extent of surgery performed (endoscopic endonasal, external or combined approaches) were analysed. A brief review of consistent literature was also carried out. Forty-seven consecutive patients were treated using an exclusive endoscopic endonasal approach (EEA) in 18 cases, while a combined endonasal with external osteoplastic approach was required in 29 cases. Most patients (29/47, 62%) had been treated previously, mainly by an endoscopic approach. A single intraoperative complication occurred (1/47, 2%), i.e. cerebrospinal fluid (CSF) leak, that was successfully repaired intraoperatively without any consequences. Recurrences were observed in only 2/47 cases (4%) after a mean follow-up of 43 months (range, 12-137). The management of inverted papilloma involving the frontal sinus requires great expertise and the surgical technique should be tailored to the site of attachment of the tumour, its extension and the anatomical conformation of each frontal sinus. The encouraging results obtained in this case series support the use of this practical treatment algorithm.

Lynch vs transcaruncular approach: optimizing access to the lateral frontal sinus

“…There are reports in the literature using adjunctive approaches such as the trephine to access isolated unilateral frontal sinus pathology, and these can be performed in isolation or with an endoscopic Draf IIA or Draf IIB 9 . Others have created an algorithm for when to employ an extended endoscopic approach in conjunction with an osteoplastic flap: typically when there is anterior or a superior posterior frontal sinus wall attachment, small AP diameter, short interorbital distance, and lateral supraorbital attachment 10 . A potential application of the findings in this study is to utilize the MELP and Lynch incision to gain full access to the lateral frontal sinus and obviate the need for an osteoplastic flap in selected individuals.…”

Surgical Approaches to the Orbit: A Neurosurgical Perspective

“…This enables the surgeon to reach further into the lateral recess of the frontal sinus by facilitating lateral displacement of the contents of the orbit. 38,39 The approach minimizes the risk of infection, minimizes the risk of scarring, and reduces postoperative morbidity and length of hospitalization. However, this approach requires knowledge of frontal sinusotomy techniques (usually Draf IIb or III), often performed by the otorhinolaryngology surgeon.…”

“…However, this approach requires knowledge of frontal sinusotomy techniques (usually Draf IIb or III), often performed by the otorhinolaryngology surgeon. 38 A Draf III approach is the most common; the frontal sinus floor is removed from the lamina papyracea from one side to the other side together with the interfrontal sinus septum to form a wide median drainage of the frontal sinus. A Draf III enables access to lesions localized in the far lateral region of the frontal sinus and permits a "two nostrils, four hands approach."…”

“…The upper portion of the lamina papyracea is then exposed, fractured, and removed taking care to preserve the periorbital layer. 38,39 A flexible retractor is introduced endonasally to lateralize the orbit and the bony aspect of the supraorbital recess is exposed. A diamond burr is used to drill out the superomedial bony orbital wall.…”

Recurrent inverted papilloma coexisted with skull base lymphoma: A case report

“…Inverted papilloma is an uncommon tumor in the sinonasal cavity, accounting for 0.5%-4% of all primary nasal tumors[ 1 , 2 ]. It mainly arises from the lateral nasal wall, with epithelial cells growing into the underlying supportive tissues.…”