Inverted papilloma

Inverted papilloma

The inverted papilloma of the paranasal sinuses (also known as papilloma papilloma Schneideriano or transitional) is a benign tumor that originates from the lateral wall of the nose and extends to the paranasal sinuses.

The tumors of the nasal cavity are evenly distributed between benign and malignant, with Inverted Papilloma which is the principal in the group of benign and malignant squamous cell carcinoma. More than 44% of cancers are attributable to occupational exposure to substances such as nickel, chromium, isopropyl oil, hydrocarbons and volatile organic fibers found in wood processing, shoes and textile industry. In addition, the papilloma viruses can act as co-factor. The treatment is surgical.

The main features of this tumor are: monolateralità, the marked tendency to recur, the local aggresività against the surrounding structures such as the cribriform plate (lamina bone that separates the brain from the nose) and papyrus lamina (bone lamina separates the eye from the nose) and the tendency to the association with malignant tumors (squamous cell carcinoma). The etiology is still unclear but certainly can be called upon several factors such as allergy, tobacco smoke, the papilloma virus. Are affected by this disease especially adults between 50 and 70 years with a predominance of males than females. The main symptoms are: the unilateral nasal respiratory obstruction, rhinorrhea and epistaxis. Endoscopic examination is possible to observe a polypoid formation of appearance and texture more 'meaty' (Fig.1) than regular polyps, often hidden by the polyps.

Inverted papilloma fig1

The TC shows the presence of a unilateral lesion of the paranasal sinuses or less extended (Fig.2).

Inverted papilloma fig2

This instrumental approach allows to evaluate carefully the surrounding bone erosion and possible intracranial extension or intraorbitaria. MRI allows to distinguish the tumor from the concomitant presence of secreted mucus or purulent mucus and make the differential diagnosis with octopus cave-Choanal that is benign. Complete surgical resection is the ideal treatment of this disease. Whether you use a more invasive surgical techniques such as lateral rhinotomy, whether using a minimally invasive surgical technique, such as endoscopic approach, it is imperative to perform a subperiosteal dissection and milling the underlying bone: this can greatly reduce relapses. In our center, the endoscopic endonasal approach is used in tumors that affect the ethmoid, the sphenoid and maxillary medial wall. If the tumor extends to the side wall of the maxillary this approach is combined with a trans-jaw approach through an incision sublabiale or directly employing the midface degloving (see chapter sull'angiofibroma nasopharyngeal) using the microscope for the removal of tumor (Figure 3).

Inverted papilloma fig3

The side rhinotomy, now abandoned at our center since replaced by midface degloving, provides for the execution of an engraving external to which, in some cases, may be followed by an aesthetically unacceptable scar. In the rare cases of inverted papilloma with intracranial extension of the midface degloving or endoscopic approach they are associated with a sub-frontal craniotomy. However, after the surgery, it is essential follow-up that includes the periodic endoscopic examination of the surgical cavity and radiological studies (CT and MRI) due to the possibility of recurrence even after many years. In particular, the periodic endoscopic examination of the nasal cavity allows the early identification of any relapses and to perform revision surgery in little invasive endoscopic and less challenging for both the surgeon and the patient.