Introduction: Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. The aim of study: was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. Material: The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. Results: Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell- Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. Conclusions: 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualifi cation for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.
Introduction: Endoscopic medial maxillectomy (EMM) refers to surgical resection of the medial wall of the maxillary antrum. The primary indications for EMM are recalcitrant maxillary sinusitis, ablation of malignant and specific benign diagnoses such as Schneiderian Papilloma. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal apparatus, optic nerve, ethmoidal arteries that may be accompanied by brisk bleeding. Aim: The purpose of this paper is to conduct a retrospective analysis of patients treated with EMM surgery at the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008–2018. Material and methods: The retrospective analysis was conducted on patients who underwent EMM treated at the the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008–2018. The research included 18 patients aged 15–94; 8 women and 10 men. Results: Out of 18 patients, 8 had been operated before EMM. 16 of them presented with histological examinations, though 5 of which were not confirmed with postoperative histological result. The most common indication for the operation was inverted papilloma. Conclusion: Endoscopic surgical approach is effective and precious way to manage tumors which involve the neighboring structures especially medial maxillary sinus. EMM itself is a safe surgical method in managing maxillary sinus disorders and is favored for its decreased invasiveness and avoidance of the deformity of face.
Inverted papilloma is a locally aggressive lesion most commonly originating from the maxillary sinus. Currently transnasal endoscopic excision is a treatment of choice in the majority of cases. The article presents the evolution of endoscopic approaches and possibilities of minimally invasive treatment in regard to tumor location.
Introduction. The aim of this study was to analyse the occurrence of inverted papillomas of the nose and paranasal sinuses in patients that underwent endoscopic sinus surgery in our department. Material and methods. Between 2006 and 2016, 3,574 patients underwent surgery due to paranasal sinus diseases. Patients were qualified for surgery based on medical history, computed tomography, and laboratory tests. Data were gathered from medical files, and they included age, sex, and histopathological diagnosis. Results. Among 3,574 patients that underwent surgery due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 patients, including 31 women (38.75%) and 49 men (61.25%). Most patients were aged 60-70 years (women, 12.5%; men, 15%) or 50-60 years (women, 5%; men, 21.25%). Between 2006 and 2016, the number of surgeries ranged from 264 (7.38%) in 2013 to 355 (9.93%) in 2016, and the number of inverted papillomas ranged from 4 in 2007 and 2015 (1.23%) to 12 in 2014 (3.87%). Over the last 4 years of the study period, the incidence of inverted papillomas increased. Conclusions. Among 3,574 patients operated on due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 cases (2.23%); thus, all patients qualified for endoscopic surgery due to inflammatory or hypertrophic changes should undergo rhino-fiberoscopy. Recurrence of inverted papillomas was observed in 17.50%, typically in patients with nasal polyps that co-occurred with inverted papillomas. We regard rhino-fiberoscopy as the most valuable method for detecting tumour recurrence in patients after surgery for inverted papillomas ranged from 4 in 2007 and 2015 (1.23%) to 12 in 2014 (3.87%). Over the last 4 years of the study period, the incidence of inverted papillomas increased. Conclusions. Among 3,574 patients operated on due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 cases (2.23%); thus, all patients qualified for endoscopic surgery due to inflammatory or hypertrophic changes should undergo rhino-fiberoscopy. Recurrence of inverted papillomas was observed in 17.50%, typically in patients with nasal polyps that co-occurred with inverted papillomas. We regard rhino-fiberoscopy as the most valuable method for detecting tumour recurrence in patients after surgery for inverted papillomas.
In recent years, the incidence of sinonasal inverted papilloma (IP) in a stable population has increased significantly. The aim of the study was to analyze the occurrence of IP between the years 2002-2012 in relation to epidemiological factors in an unalterable area. Moreover, we wanted to start a discussion about the difficulties in determining the inci¬dence of benign lesions that are not included in registers. This retrospective study included a group of 69 patients who were treated in the Department of Otolaryngology, ENT Oncology, Poznań University of Medical Sciences. In 2006, we noticed a sudden change in referrals. We compared two groups of patients who were referred during two differ¬ent time periods: 11 patients (2002-2006) and 58 patients (2007-2012). Despite a marked difference in the number of patients, there were no differences between the groups in tumor location (p>0.05), stage (p=0.16), duration of symp¬toms (p=0.39), place of residence, and smoking (p=0.41). The patient`s age was the only variable that differed significantly between the groups (48.45 vs. 56.93 years; p=0.043569, respectively).
Objective: Sinonasal inverted papilloma has been traditionally managed with external surgical approaches. Advances in imaging guidance systems, surgical instrumentation, and intraoperative multi-visualization have led to a gradual shift from external approaches to endoscopic surgery. However, for anatomical and technical reasons, endoscopic surgery of sinonasal inverted papilloma extending to the frontal sinuses is still challenging. Here, we present our experience in endoscopic surgical management of sinonasal inverted papilloma extending to one or both frontal sinuses. Methods: We present 10 cases of sinonasal inverted papilloma extending to the frontal sinuses and successfully removed by endoscopic median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. Results: The whole cavity of the frontal sinuses was easily inspected at the end of the surgical procedure. No early or late complications were observed. No recurrence was identified after an average follow-up period of 39.5 months. Conclusion: Use of an endoscopic median drainage approach to manage sinonasal inverted papilloma extending to one or both frontal sinuses is feasible and seems effective.
Objective: Sinonasal inverted papilloma has been traditionally managed with external surgical approaches. Advances in imaging guidance systems, surgical instrumentation, and intraoperative multi-visualization have led to a gradual shift from external approaches to endoscopic surgery. However, for anatomical and technical reasons, endoscopic surgery of sinonasal inverted papilloma extending to the frontal sinuses is still challenging. Here, we present our experience in endoscopic surgical management of sinonasal inverted papilloma extending to one or both frontal sinuses. Methods: We present 10 cases of sinonasal inverted papilloma extending to the frontal sinuses and successfully removed by endoscopic median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. Results: The whole cavity of the frontal sinuses was easily inspected at the end of the surgical procedure. No early or late complications were observed. No recurrence was identified after an average follow-up period of 39.5 months. Conclusion: Use of an endoscopic median drainage approach to manage sinonasal inverted papilloma extending to one or both frontal sinuses is feasible and seems effective.
Cel: Klasyczne metody leczenia brodawczaka odwróconego jam nosa i zatok przynosowych to zabiegi z dostępu zewnątrznosowego. Postępy w technikach nawigowania obrazowaniem, rozwój narzędzi chirurgicznych oraz metod obrazowania śródoperacyjnego doprowadziły do stopniowego odejścia od dostępów zewnątrznosowych na rzecz chirurgii endoskopowej. Ze względów anatomicznych i technicznych, chirurgia endoskopowa w leczeniu brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do zatok czołowych wciąż pozostaje wyzwaniem. Poniżej przedstawiono doświadczenia własne autorów dotyczące chirurgii endoskopowej w leczeniu brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do jednej lub obu zatok czołowych. Metody: Zaprezentowano 10 przypadków brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do zatok czołowych, usuniętego skutecznie za pomocą wewnątrznosowego otwarcia obu zatok czołowych (Draf III) pod kontrolą endoskopu, bez dodatkowego dojścia zewnątrznosowego. Wyniki: Po zakończonym zabiegu chirurgicznym cała jama obu zatok czołowych mogła być w łatwy sposób kontrolowana. Nie obserwowano ani wczesnych, ani późnych powikłań. Po średnim okresie obserwacji (39,5 miesiąca), nie odnotowano nawrotów. Wnioski: Zastosowanie dojścia endoskopowego z obustronnym otwarciem zatok czołowych w leczeniu brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do jednej lub obu zatok czołowych jest możliwe i wydaje się być skuteczne.
Cel: Klasyczne metody leczenia brodawczaka odwróconego jam nosa i zatok przynosowych to zabiegi z dostępu zewnątrznosowego. Postępy w technikach nawigowania obrazowaniem, rozwój narzędzi chirurgicznych oraz metod obrazowania śródoperacyjnego doprowadziły do stopniowego odejścia od dostępów zewnątrznosowych na rzecz chirurgii endoskopowej. Ze względów anatomicznych i technicznych, chirurgia endoskopowa w leczeniu brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do zatok czołowych wciąż pozostaje wyzwaniem. Poniżej przedstawiono doświadczenia własne autorów dotyczące chirurgii endoskopowej w leczeniu brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do jednej lub obu zatok czołowych. Metody: Zaprezentowano 10 przypadków brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do zatok czołowych, usuniętego skutecznie za pomocą wewnątrznosowego otwarcia obu zatok czołowych (Draf III) pod kontrolą endoskopu, bez dodatkowego dojścia zewnątrznosowego. Wyniki: Po zakończonym zabiegu chirurgicznym cała jama obu zatok czołowych mogła być w łatwy sposób kontrolowana. Nie obserwowano ani wczesnych, ani późnych powikłań. Po średnim okresie obserwacji (39,5 miesiąca), nie odnotowano nawrotów. Wnioski: Zastosowanie dojścia endoskopowego z obustronnym otwarciem zatok czołowych w leczeniu brodawczaka odwróconego jam nosa i zatok przynosowych rozprzestrzeniającego się do jednej lub obu zatok czołowych jest możliwe i wydaje się być skuteczne.
INTRODUCTION: Sinonasal inverted papillomas (IPs) are a major challenge for ENT specialists. In the last decades, the number of endoscopic procedures has increased, while the percentage of external or double approach procedures has decreased. The aim of this study was to evaluate long-term IP treatment outcomes according to the applied surgical method. MATERIAL AND METHODS: the retrospective study included 69 patients (28 women and 41 men) treated during 2002–2012 in the Department of Otolaryngology and Laryngological Oncology of Poznań University of Medical Sciences. Of these patients, 47 were operated endoscopically, 16 received a double procedure and six received an external procedure. RESULTS: The recurrence rate in patients treated endoscopically was 32%, while patients treated by the external/double approach showed 64% (p = 0.03306). The recurrence rate after endoscopic surgery was 75% during 2002–2006, but was 28% during 2007–2012. There was no correlation between recurrence rate and age (p = 0.087686), gender (p = 0.42810), type of symptoms (p = 0.20955), or Krouse staging (p = 0.23658). A significant impact on relapses was the position to Ohngren’s plane (p = 0.004768) and tumor location in the anterior ethmoid (p = 0.00416). DISCUSSION: Endoscopic procedures are an effective method of IP treatment, however reasonable indications and surgeon experience should be taken into consideration.
Background: Unilateral sinus disease (USD) occurs in 23 % of all cases. It is believed that it is mainly associated with cancer development. Retrospective data from large rhinological centers show that the most common USD is chronic rhinosinusitis (CRS), followed by mycosis, inverted papilloma and finally cancer, but only in a small percent of cases. The aim of the study: The analysis of USD in the group of patients who underwent FESS at the secondary referral center. Material and Method: The retrospective study of patients treated for USD in the Department of Otolaryngology in the Provincial Hospital in Poznan between June 2014 and June 2016. The analysis includes age, sex, the localization of lesions, histopathological and microbiological results, an extension of the surgery and treatment results. Results: Over the analyzed period of time, 415 FESS for chronic sinusitis were performed. In this group, 83 patients underwent surgery for USD. There were 35 women and 48 men.CRS was found in 48 cases, mycosis in nine cases, 12 patients were operated for non-malignant tumors, such as inverted papilloma (9), osteoma (2) and fibrosis tumor(1); seven patients had a choanal polyp and two of them had a foreign body in maxillary sinus – a tooth root lying loose. Four patients were diagnosed with a hypoplastic maxillary sinus and one patient suffered from frontal sinus pyocele. One side endoscopic opening of all sinuses was performed in the group with CRS, endoscopic medial maxillectomy was conducted in patients with inverted papilloma, and an isolated opening of the affected sinus was performed in the cases with mycosis. Conclusions: USD must be always suspected of malignant degeneration until proven otherwise. Endoscopic sinus surgery with the use of angled scope allows for the removal of even very extensive lesions. In our opinion, the extent of operation is determined by the nature of pathology. While extensive surgery is recommended in patients with inverted papilloma, a limited procedure should be performed in those with isolated mycosis.
Background: Unilateral sinus disease (USD) occurs in 23 % of all cases. It is believed that it is mainly associated with cancer development. Retrospective data from large rhinological centers show that the most common USD is chronic rhinosinusitis (CRS), followed by mycosis, inverted papilloma and finally cancer, but only in a small percent of cases. The aim of the study: The analysis of USD in the group of patients who underwent FESS at the secondary referral center. Material and Method: The retrospective study of patients treated for USD in the Department of Otolaryngology in the Provincial Hospital in Poznan between June 2014 and June 2016. The analysis includes age, sex, the localization of lesions, histopathological and microbiological results, an extension of the surgery and treatment results. Results: Over the analyzed period of time, 415 FESS for chronic sinusitis were performed. In this group, 83 patients underwent surgery for USD. There were 35 women and 48 men.CRS was found in 48 cases, mycosis in nine cases, 12 patients were operated for non-malignant tumors, such as inverted papilloma (9), osteoma (2) and fibrosis tumor(1); seven patients had a choanal polyp and two of them had a foreign body in maxillary sinus – a tooth root lying loose. Four patients were diagnosed with a hypoplastic maxillary sinus and one patient suffered from frontal sinus pyocele. One side endoscopic opening of all sinuses was performed in the group with CRS, endoscopic medial maxillectomy was conducted in patients with inverted papilloma, and an isolated opening of the affected sinus was performed in the cases with mycosis. Conclusions: USD must be always suspected of malignant degeneration until proven otherwise. Endoscopic sinus surgery with the use of angled scope allows for the removal of even very extensive lesions. In our opinion, the extent of operation is determined by the nature of pathology. While extensive surgery is recommended in patients with inverted papilloma, a limited procedure should be performed in those with isolated mycosis.
INTRODUCTION: Sinonasal inverted papillomas (IPs) are a major challenge for ENT specialists. In the last decades, the number of endoscopic procedures has increased, while the percentage of external or double approach procedures has decreased. The aim of this study was to evaluate long-term IP treatment outcomes according to the applied surgical method. MATERIAL AND METHODS: the retrospective study included 69 patients (28 women and 41 men) treated during 2002–2012 in the Department of Otolaryngology and Laryngological Oncology of Poznań University of Medical Sciences. Of these patients, 47 were operated endoscopically, 16 received a double procedure and six received an external procedure. RESULTS: The recurrence rate in patients treated endoscopically was 32%, while patients treated by the external/double approach showed 64% (p = 0.03306). The recurrence rate after endoscopic surgery was 75% during 2002–2006, but was 28% during 2007–2012. There was no correlation between recurrence rate and age (p = 0.087686), gender (p = 0.42810), type of symptoms (p = 0.20955), or Krouse staging (p = 0.23658). A significant impact on relapses was the position to Ohngren’s plane (p = 0.004768) and tumor location in the anterior ethmoid (p = 0.00416). DISCUSSION: Endoscopic procedures are an effective method of IP treatment, however reasonable indications and surgeon experience should be taken into consideration.
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