phenylephrine-hydrochloride and Papilloma--Inverted

To show a rare case of inverted papilloma with bilateral origin treated with endoscopic approach MATERIAL OF STUDY: The authors reported the unusual case of a 71-year-old male patient with a growing mass occupying both nasal cavities. The patient complained bilateral nasal obstruction associated with thick nasal secretions, anterior and posterior nasal drip, snoring and diffuse nasal pain. The biopsy revealed inverted papilloma.. CT Scan and RMI of paranasal sinuses showed a bilateral origin of the tumor with a triple involvement on the left side: middle turbinate axilla, frontal recess posterior wall and ethmoidal sinus roof. Nasal endoscopic surgery approach was performed and the tumoral mass was removed completely.. Inverted papilloma is an uncommon primary nasal tumor that presents three typical characteristics: a high rate of recurrence, local aggressive behaviour and association with malignancy. Although bilaterality is very rare, in this case the neoplasia occupied both nasal cavities with extension to left frontal, sphenoid and ethmoid sinuses.. The authors, in line with the literature, showed that endoscopic approach represents once again a safe and efficient technique, even for larger tumors.. Bilateral origin, Inverted papilloma, Paranasal sinuses.. Il papilloma invertito è un tumore delle cavità nasali e dei seni paranasali che presenta tre caratteristiche: una discreta aggressività locale, una marcata capacità di ricorrenza e una possibile associazione con tumori maligni, spesso carcinomi squamocellulari. Secondo la nuova classificazione WHO dei tumori testa e collo, rientra, con il papilloma oncocitico ed il papilloma esofitico, tra i “papillomi dei seni paranasali” che, nel loro insieme, rappresentano una bassa percentuale (0.4-4.7%) di tutti i tumori dei seni paranasali. La bilateralità è molto rara mentre il tasso di trasformazione maligna si attesta intorno al 13-14%. Si manifesta, di solito, con ostruzione nasale monolaterale, epistassi, rinorrea, iposmia e cefalea frontale. L’esame istopatologico è essenziale per la diagnosi mentre le indagini strumentali, come la TC del Massiccio Facciale, permettono di identificare la sede della lesione e di valutare l’espansione e l’eventuale erosione ossea del tumore. Il trattamento di scelta prevede l’escissione di tutta la massa tumorale spesso per via endoscopica mentre il trattamento radioterapico adiuvante è riservato ai casi in cui sono presenti focolai di carcinoma. Il caso clinico esaminato riguarda un paziente di 71 anni giunto in ospedale per ostruzione nasale associata a rinorrea mucosa, russamento e diffuso dolore facciale. L’esame otorinolaringoiatrico ha mostrato la presenza di una massa obliterante entrambe le cavità nasali che, in seguito a biopsia, risultava essere un papilloma invertito. Attraverso tecniche di imaging quali TC e Risonanza Magnetica del Massiccio Facciale è emerso che il tumore originava da entrambe le fosse nasali, a destra a livello dell’ascella del turbinato medio mentre a sinistra aveva una tripla sede di origine: ascella del turbinato medio, parete posteriore del recesso frontale e tetto dell’etmoide. Il paziente, sotto anestesia generale e per via endoscopica, è stato sottoposto a rimozione della massa tumorale tramite “debrider”, a maxillectomia mediale di tipo I sinistra, a senectomia frontale “Draf III” e ad asportazione della massa dal tetto etmoidale fino al livello della porzione paraclivale dell’arteria carotidea interna. Il materiale asportato è stato analizzato e l’esame istopatologico ha confermato la diagnosi di papilloma invertito escludendo comunque segni di malignità. Due settimane dopo l’intervento, il paziente è stato sottoposto ad un’ulteriore TC del Massiccio Facciale che non ha mostrato nessuna p

Topics: Aged; Endoscopy; Humans; Male; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.. Seltene Erkrankungen der Nase, der Nasennebenhöhlen und der vorderen Schädelbasis stellen aufgrund der niedrigen Inzidenz und den daraus resultierend eingeschränkten diagnostischen Kriterien sowie therapeutischen Optionen eine Herausforderung dar. Der Schwellenwert, ab dem eine Erkrankung als selten zu werten ist, liegt bei höchstens 5 Betroffenen pro 10 000 Personen. Innerhalb dieser Erkrankungen gibt es allerdings extreme Schwankungen. So gehören einige seltene Erkrankungen, wie z.B. das invertierte Papillom, zu den regelmäßig diagnostizierten und therapierten Krankheitsbildern einer größeren Klinik für Hals-Nasen-Ohrenheilkunde. Andererseits liegen bei anderen seltenen Erkrankungen und Fehlbildungen weltweit deutlich unter 100 Fallberichte vor, was die Notwendigkeit einer Bündelung der verfügbaren Erfahrung zu Diagnostik und Therapie unterstreicht.Die vorliegende Arbeit gibt eine Übersicht zu seltenen Erkrankungen der Nase, der Nasennebenhöhlen und der vorderen Schädelbasis aus den übergeordneten Bereichen Erkrankungen / Syndrome des olfaktorischen Systems, Fehlbildungen der Nase und Nasennebenhöhlen, Belüftungs- und Funktionsstörungen sowie benigne und maligne Tumore. Die Einordnung sowie Angaben zu Diagnostik und Therapiemöglichkeiten wurden unter Berücksichtigung der aktuellen Literatur erstellt.

Topics: Humans; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Paranasal Sinuses; Rare Diseases; Skull Base

To investigate the recurrence rate of nasal inverted papilloma treating by endoscopic and non-endoscopic approach.. A search on Pubmed, Medline, Springer and Elsevier databases was done to collect the reports (2001-2013) concerning different surgery treating nasal inverted papillomas, and meta-analysis was performed with RevMan 5.0 software.. Twelve papers (2001-2013) concerning the different surgery approach treating nasal inverted papillomas were retrieved. The heterogeneity test indicated that the 12 studies were consistent statistically (Q = 14.64, df = 11, P = 0.20), the data from these 12 studies could be analyzed by fixed effect model. After combination of these data, those of 1012 subjects accepted endoscopic surgical intervention and 359 subjects treating by non-endoscopic surgical intervention were collected. Test of overall effect by fixed effect model showed that the recurrence rate of inverted papilloma was significantly lower in endoscopic group than in non-endoscopic group (OR = 0.49, 95% CI was 0.35-0.69, P < 0.01). Funnel plot implied that publication bias was not obvious.. The recurrence rate of inverted papilloma was significantly lower in endoscopic group than in non-endoscopic group.

Topics: Endoscopy; Humans; Nasal Surgical Procedures; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted; Retrospective Studies

We report on the metachronic appearance of an inverted papilloma in the ipsilateral middle ear after resection of an endonasal inverted papilloma and its malignant transformation. After multiple surgical interventions and adjuvant radiation and chemotherapy, there was recurrence with intracerebral growth, which ultimately led to the patient's death 3 years after the initial presentation.. Wir berichten über das metachrone Auftreten eines invertierten Papilloms im ipsilateralen Mittelohr nach Resektion eines endonasalen invertierten Papilloms sowie über dessen maligne Transformation. Nach mehrfachen sanierenden Operationen sowie adjuvanter Radiochemotherapie kam es zu einem Rezidiv mit intrazerebraler Manifestation. Diese führte zum Tod der Patientin drei Jahre nach Erstvorstellung.

Topics: Ear, Middle; Eustachian Tube; Humans; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted

Topics: Endoscopy; Humans; Nose; Papilloma, Inverted; Paranasal Sinus Neoplasms

We previously reported a modified endoscopic medial maxillectomy (modified transnasal endoscopic medial maxillectomy through prelacrimal duct approach [MTEMMPDA]) to resect inverted papilloma (IP), for which the inferior turbinate (IT) and nasolacrimal duct (ND) can be preserved. MTEMMPDA is a safe and effective method to obtain wide, straight access to the maxillary sinus (MS). However, there are few reported cases of patients who underwent MTEMMPDA, and even fewer of patients who underwent partial osteotomy of the apertura piriformis and the anterior wall of the MS. In this study, we analyzed the outcomes of 51 patients who underwent MTEMMPDA.. Retrospective review.. All patients who underwent MTEMMPDA at our hospital between January 2004 and December 2015 were included in this study.. Fifty-one patients with sinonasal IP in the MS underwent MTEMMPDA. Recurrence was seen in the MS of one patient (follow-up of 2-138 months). The IT remained unchanged in all 51 patients without atrophy. We have not observed epiphora, eye discharge, dry nose, or persistent crusting after this surgery. Although seven patients had numbness around the upper lip after surgery, this had disappeared by 1 year after surgery. Additional partial osteotomy of the apertura piriformis and the anterior wall of the MS were done in eight patients. Deformation of the external nose was not seen.. This approach appears to be a safe and effective method to resect IP in the MS, even if there is additional partial osteotomy of the apertura piriformis and the anterior wall of the MS.. 4. Laryngoscope, 127:2205-2209, 2017.

Topics: Adolescent; Adult; Aged; Child; Facial Bones; Female; Humans; Lacrimal Apparatus; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Middle Aged; Natural Orifice Endoscopic Surgery; Neoplasm Recurrence, Local; Nose; Osteotomy; Papilloma, Inverted; Retrospective Studies; Treatment Outcome; Young Adult

The expression of C/EBPα, CK10 in nasal inverted papilloma (NIP) were detected in the study. Further discussed their significance in genesia, development and recurrence of NIP.. Three groups including nasal cavity mucosae (NM 10 cases), nasal polyp (NP 20 cases) and NIP (30 cases) were selected in the study. Expretion of C/EBPα, CK10 were detected by immunohistochemisty PV-6000 method.. (1) The different expression of C/EBPα and CK10 in the group of NM, NP and NIP was statistically significant (P < 0.05). (2) The different expression of C/EBPα, CK10 in the group of benign NIP and NIP with atypical hyperplasia was statistically significant (P < 0.05). (3) The different expression of C/EBPα and CK10 in the group of NIP with recurrence and NIP with no recurrence was statistically significant, P < 0.05, respectively. (4) Our result indicate that the relationship of C/EBPα and CK10 (r = 0.578, P < 0.01) was direct correlation. The difference was statistically significant.. In conclusion, the present results describe C/EBPα, CK10 expression in NIP and their possible implication in the regulation of tumor growth and differentiation. C/EBPα and CK10 production may prove useful in terms of a prognostic marker for the recurrence in nasal inverted papilloma.

Topics: CCAAT-Enhancer-Binding Proteins; Humans; Keratin-10; Nasal Polyps; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted

To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries.. Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3).. Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed.. Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.

Topics: Cerebrospinal Fluid Leak; Endoscopy; Fibroma, Ossifying; Humans; Nasal Surgical Procedures; Neurosurgical Procedures; Nose; Papilloma, Inverted; Paranasal Sinuses; Retrospective Studies; Sinusitis; Sphenoid Bone; Surgery, Computer-Assisted

To evaluate the surgical outcomes and recurrence rate of inverted papillomas (IPs).. The medical records of patients diagnosed as IPs at Songklanagarind Hospital between January 2004 and December 2012 were retrospectively reviewed. Demographic data, clinical presentation, type of surgical approach, complications, and recurrence status were collected.. From 64 patients, 75% were male. The average age was 55 years. IPs were classified in Krouse's classification system as followed: stage I = 6.3%, stage II = 21.9%, stage III = 70.3%, and stage IV = 1.5%. The surgical approaches were divided into endoscopic endonasal approach (EEA) 60.9%, EEA combined with external approach 35.9%, and external approach 3.2%. Complications such as synechea and maxillary sinus ostium stenosis occurred in 29.7% of patients. Thirty-seven point five percent had disease recurrence after surgery, most commonly at the frontal sinus 82.4%, and sphenoid sinus 60%.. EEA is an effective treatment for IPs, especially in Krouse's classification stage I, II. The external approach combined with E A could be useful when the tumor extends to the anterolateral wall of the maxillary sinus. Finally, the surgeon must pay particular attention to the frontal and sphenoid sinus because of the high local recurrence rate.

Topics: Adult; Female; Humans; Male; Medical Records; Middle Aged; Natural Orifice Endoscopic Surgery; Neoplasm Recurrence, Local; Neoplasm Staging; Nose; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Thailand; Tissue Adhesions; Treatment Outcome

To evaluate the effect of endoscopic surgery for maxillary sinus inverted papilloma.. From 2000 to 2011, 50 patients with maxillary sinus inverted papilloma were treated with intranasal endoscopic surgery or combined approach. Among them, 39 cases were primary and 11 cases were recurrent, which included 17 patients with Krouse stage IIand 33 cases with Krouse stage III. Different surgical approaches were selected according to the range and positions of the lesions. One case with severe atypical hyperplasia received postoperative radiotherapy.. All cases were followed up for 3-14 years, 7 cases recurred. All occurrence within 2 years after operation. Malignant change and death was found in 1 case. After operation, epiphora occurred in 2 cases, maxillary sinus labiogingival groove fistula occurred in 2 cases, facial numbness occurred in 4 cases and incision hemorrhage occurred in 1 case. All the complications were cured after appropriate treatment.. Naso-endoscopic surgery or combined approach is a safe, effective and microinvasive treatment for patients with maxillary sinus inverted papilloma. Accurate selection of suitable approach according to the range and positions of the lesions and correct management of the base of the tumor are critical to the success of the operation.

Topics: Endoscopy; Humans; Lacrimal Apparatus Diseases; Maxillary Sinus; Maxillary Sinus Neoplasms; Nasal Surgical Procedures; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Postoperative Period; Retrospective Studies

The aim of this study was to describe the endoscopic medial maxillectomy technique with preservation of the inferior turbinate in patients affected by maxillary sinonasal inverted papilloma. We retrospectively reviewed the clinical charts and surgical technique in six patients with paranasal sinus inverted papilloma. There were five males and one female, whose mean age at diagnosis was 60 years ranging between 57 and 65 years. No recurrences were diagnosed, and no nasal crusting was evidenced postoperatively. Nasal breathing was satisfying in all cases. Postoperative epistaxis was not observed, and none of the patients refereed to have epiphora after the surgery. This technique has been successfully performed, showing no recurrence to the present and allowing the preservation of a functional inferior turbinate.

Topics: Aged; Endoscopy; Female; Follow-Up Studies; Humans; Male; Maxilla; Middle Aged; Neoplasm Recurrence, Local; Nose; Otorhinolaryngologic Surgical Procedures; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Treatment Outcome; Turbinates

We report a rare case of new bone formation (osteogenesis) within an inverted papilloma, occurring in the ethmoid and frontal sinuses.. The histopathological and radiological findings, differential diagnosis, and treatment of tumour-induced osteogenesis are discussed.. A 68-year-old man complained of headache and left-sided, purulent rhinorrhoea of five years' duration. On nasal endoscopy, lesions similar to inflammatory nasal polyps were seen. Pre-operative radiological images demonstrated opacification of the left nasal cavity and anterior ethmoid and frontal sinuses, plus a bone-density lesion. The mass with bony lesion was completely removed endoscopically. The mass was histopathologically diagnosed as an inverted papilloma surrounding bony tissue. Furthermore, the histopathological findings (including immature bony tissue rimmed by osteoblasts) indicated an extremely rare case of inverted papilloma induced osteogenesis. Six months after surgery, no recurrence was detected.. This case highlights the importance of clinical awareness of tumour-induced osteogenesis.

Topics: Aged; Endoscopy; Ethmoid Sinus; Frontal Sinus; Humans; Male; Nose; Ossification, Heterotopic; Papilloma, Inverted; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome

To introduce and evaluate the effectiveness and safety of transnasal endoscopic anterior and medial maxillectomy (TEAMM) in the treatment of Krouse stage III inverted papilloma (IP) originating from the maxillary sinus.. A retrospective chart review was performed for 33 patients with Krouse stage III IP undergoing TEAMM in our hospital between 2003 and 2008.. Tumors were completely resected through TEAMM. Sixteen cases had type I TEAMM, during which the nasolacrimal duct was preserved; 17 had type II TEAMM, during which the nasolacrimal duct was resected. The inferior turbinate was partially preserved in 26 cases. Patients were followed for a mean of 40.4 months. Recurrence developed in 2 patients, dry nose syndrome in 5 patients, and epiphora in 1 patient. Squamous cell carcinoma occurred in 1 patient.. TEAMM is an effective and safe technique in the management of Krouse stage III IP and provides good exposure of operative cavities during follow-up.

Topics: Adult; Aged; Endoscopy; Female; Humans; Male; Maxilla; Maxillary Sinus; Maxillary Sinus Neoplasms; Middle Aged; Nose; Osteotomy; Papilloma, Inverted; Tomography, X-Ray Computed

Inverted papillomas are primarily benign neoplasms that occur in the nasal cavity and paranasal sinuses. Many aspects of sinonasal inverted papillomas are still controversial and active fields of research. Inverted papillomas generate considerable interest because they are locally aggressive, have a propensity to recur and are associated with malignancy. However, neither the etiology and pathogenesis of these tumors nor the putative role as a precursor to carcinoma and the factors responsible for associated malignancy have been clarified. Whether carcinomas in inverted papillomas arise meta- or synchronous is also still unknown.. In a retrospective study we reviewed the charts of 93 patients with sinonasal inverted papillomas who were treated at our department between 1990 and 2007. Comparison was made between the group of patients with inverted papillomas and associated squamous cell carcinomas and the group of patients with benign inverted papillomas. We undertook a critical analysis of our results compared with the international medical literature.. Associated malignancy was found in 11 patients (11.8 %). In each one case a metachronous carcinoma with and without recurrent inverted papilloma was diagnosed, the remaining 9 carcinomas were determined to be synchronous malignancies. Our data suggest, that the association between carcinoma and inverted papilloma is indirect and that the gradual progression from inverted papilloma to a malignant neoplasm is if at all infrequent. Male gender, advanced age and recurrent inverted papilloma do not per se present risk factors for the development of associated malignancies.. Sinonasal carcinomas arise in about 10 % of patients with inverted papillomas, but the ratio of metachronous carcinomas has possibly been overrated up to now. Nevertheless, regular follow-up investigations after surgical resection of inverted papillomas are mandatory. The assumption, that carcinomas in inverted papillomas are less aggressive than carcinomas alone and the definition of high-risk groups for the development of carcinomas seems hazardous.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Middle Aged; Neoplasm Staging; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Risk Factors; Sphenoid Sinus; Time Factors

The aim of this article is to present the technique of endonasal operation due to sinonasal inverted papilloma with it's limitations. Material consists of 21 patients operated with microscope and endoscopes. The tumor is resected in few pieces, but I try (especially in the beginning) to keep the resected tumor as much as possible in one part--which makes easier to assess the tumor borders. Mostly it is possible to leave at place the inferior turbinate and only the upper part of it must be resected with the tumor. Involvement of the frontal sinus is the contraindications for a purely endonasal approach, but this involvement must be assessed intraoperatively, due to preoperative CT scan limitations. Tumor involving the orbit is also contraindication to endonasal approach. Tumor is resected with anterior or total ethmoidectomy, because of coexistence of inflammations in sinuses. It is possible to resect tumor from all ethmoid cells and both sphenoid sinuses from endonasal approach. Mostly it is possible to resect tumor from maxillary sinus from endonasal approach. I leave a healthy mucosa of the maxillary sinus and resect only tumor and the margins. But in the case of prelacrimal recess involvement of the maxillary sinus or difficulty with removing tumor from the bottom of the sinus I open it through the Caldwell-Luck approach (2 cases). Postoperative cavity usually heals very well. In the presented material I didn't observed recurrence of the tumor and the patients are very well (17 patients: 1-4.5 years of observation, 4 patients: under 1 year of observation). Advantages of the endonasal method are: small bleeding, operation under magnification, good view around the corner in 70 degrees endoscope, leaving anterior bony wall of the maxillary sinus, leaving inferior turbinate and small post-op. disturbances, relatively small op. injury and quick healing, possibility of removing the tumor from the nose, ethmoidal and sphenoidal and maxillary sinuses (mostly), possibility to extend the operation with external approaches if needed. Disadvantages and limits of the method are: not possible to remove the tumor from frontal sinus, difficulty in removing the tumor from prelacrimal sac recess (sometimes combined approach needed).

Topics: Adult; Aged; Aged, 80 and over; Endoscopy; Ethmoid Sinus; Female; Humans; Male; Maxillary Sinus Neoplasms; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Papilloma, Inverted; Paranasal Sinus Neoplasms; Treatment Outcome

To compare endoscopic approach with lateral rhinotomy for treatment of the sinonasal inverted papilloma in terms of advantage, indications and limitations of the procedures.. Eighty-six cases with inverted papilloma were reviewed retrospectively, among which 23 cases underwent transnasal endoscopic procedures including 10 combined with Caldwell-Luc intervention, and 63 cases underwent lateral rhinotomy. The follow-up period ranged from 11 - 36 m (mean 23 m). The data were processed statistically by SPSS 10.0 software.. Both procedures permitted removal of most sinonasal inverted papilloma. The endoscopic surgery provided an excellent visualization, and preserved a vital anatomic structure and left no facial scar. Lateral rhinotomy was associated with postoperative facial scar or deformity. The recurrence rate in lateral rhinotomy group was 9.5% and in endoscopic approach was 13% (P >0.05).. Endoscopic approach is favored for the treatment of non-massively extending sinonasal inverted papilloma because of an acceptable recurrence and a better cosmetic results.

Topics: Adolescent; Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Otorhinolaryngologic Surgical Procedures; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Treatment Outcome

To demonstrate the potentials and limitations of three different endoscopic procedures employed for treatment of inverted papilloma (IP) of the sinonasal tract.. Retrospective analysis of a cohort of patients treated at two University hospitals.. From January 1992 to June 2000, 47 patients with IP underwent endoscopic resection. Preoperative workup included multiple biopsies of the lesion and imaging evaluation by computed tomography or magnetic resonance imaging. Massive skull base erosion, intradural or intraorbital extension, extensive involvement of the frontal sinus, abundant scar tissue caused by previous surgery, or the concomitant presence of squamous cell carcinoma were considered absolute contraindications for a purely endoscopic approach. Three types of resection were used: ethmoidectomy with wide antrostomy and sphenoidotomy (type 1) for IPs confined to the middle meatus, medial maxillectomy with ethmoidectomy and sphenoidotomy (type 2) for IPs partially invading the maxillary sinus, and a Sturmann-Canfield operation (type 3) for IPs involving the mucosa of the alveolar recess or of the anterolateral corner of the maxillary sinus. All patients were followed by periodic endoscopic evaluations.. Type 1, 2, and 3 resections were performed in 26, 15, and 6 patients, respectively. No recurrences were observed after a mean follow-up of 55 (range 30-132) months. One patient, who underwent a type 2 resection, developed a stenosis of the lacrimal pathways requiring endoscopic dacryocystorhinostomy.. Our experience confirms that endoscopic surgery is an effective and safe method of treatment for most IPs. The availability of different endoscopic techniques allows the entity of the dissection to be modulated in relation to the extent of disease. Strict application of selection criteria, meticulous use of subperiosteal dissection in the involved areas, and regular follow-up evaluation are key elements for success.

Topics: Adult; Aged; Biopsy; Endoscopy; Ethmoid Sinus; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinus; Middle Aged; Nose; Papilloma, Inverted; Paranasal Sinus Neoplasms; Sphenoid Sinus; Tomography, X-Ray Computed

Total or near-total rhinectomy during tumor ablative surgery creates a large postsurgical defect. Surgical or prosthetic reconstruction may be considered. Surgical reconstruction of such a defect depends on support of the reconstructive tissues to prevent collapse. Without support, the esthetic results and airway patency are compromised. The purpose of this clinical report is to present the use of a nasal stent to support soft and hard tissues for the reconstruction of near-total rhinectomy in 2 patients.

Topics: Adult; Aged; Bone Transplantation; Carcinoma, Squamous Cell; Cartilage; Equipment Design; Fascia; Humans; Male; Nose; Nose Neoplasms; Papilloma, Inverted; Plastic Surgery Procedures; Skin Transplantation; Stents

The aim of the investigation was to determine the influence of complete resection of the turbinates and the lateral nasal wall on nasal deposition of particulate matter with an aerodynamic diameter of 10 microm or less (pm10) and its relation to nasal patency and geometry.. Retrospective study.. Eight patients were enrolled in the study after unilateral sinus surgery for a unilateral inverted papilloma of the sinuses. Particle deposition from the inhaled and exhaled air was measured by means of a laser particle counter in the nasal valve area and the nasopharynx during nose-only breathing and nose-in, mouth-out breathing. The data on deposited fraction for the operated side were compared with the data for the untreated, healthy side. Rhinomanometry and acoustic rhinometry were performed.. Particle deposition did not differ significantly between the operated and untreated sides of the nose at both detection sites. No correlation between the deposited fraction and rhinomanometric and rhinometric values was found.. Radical resection of the turbinates does not seem to disturb particle deposition (pm10) measured in the nose to a significant degree. Factors other than impaction and sedimentation onto the mucosal surface of the turbinates seem to be sufficient for effective particle deposition after radical removal of the turbinates.

Topics: Adult; Aged; Cartilage; Female; Humans; Male; Middle Aged; Nasal Cavity; Nasal Mucosa; Nasopharynx; Nose; Otorhinolaryngologic Surgical Procedures; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Turbinates

To describe the new technique of transnasal endoscopic medial maxillectomy.. Study design included application of the new technique in the management of five patients with inverting papilloma; retrospective review of five patients who had lateral rhinotomy with medial maxillectomy for inverting papilloma; comparison of transnasal endoscopic medial maxillectomy to open medial maxillectomy for scope of resection, margin control, operative time, and surgical access; and detailed description of transnasal endoscopic medial maxillectomy.. Charts were reviewed and tabulated for operative time, duration of follow-up, and recurrence. Pathology reports were reviewed for number and orientation of the specimens and for margin control.. Operative time was shorter for patients managed with transnasal endoscopic medial maxillectomy. All patients with transnasal endoscopic medial maxillectomy had one large, well-oriented specimen with margin control. There was no recurrence in either group.. Transnasal endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial maxillectomy for selected patients. Maxillary sinus involvement with inverting papilloma is not a contraindication for this technique. Strong illumination, superior resolution, and angled visualization, coupled with exact osteotomies, make transnasal endoscopic medial maxillectomy an efficacious technique for inverting papilloma with extension limited to the maxillary and ethmoid sinuses.

Topics: Endoscopy; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Maxillary Sinus; Neoplasm Invasiveness; Neoplasm Staging; Nose; Papilloma, Inverted; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed

To determine a putative role and relation between human papilloma virus (HPV) and p53 in the etiology of sinonasal carcinomas associated with papillomas.. The study group consists of all patients with sinonasal carcinomas associated with papillomas diagnosed in Denmark from 1980 to 1998. After reviewing our national pathological files, tumor tissues from 36 patients were collected, comprising 15% of the total cases of sinonasal carcinomas. In 35 cases a squamous cell carcinoma was demonstrated and in one case an adenocarcinoma was evident. Inverted papilloma was associated with carcinoma in 31 cases and exophytic papillomas in 5 cases. The material was investigated for HPV using polymerase chain reaction analyses with two sets of consensus primers (GP5+/GP6+ and MY09/MY11). The HPV-positive cases were submitted to dot-blot hybridization to establish the HPV type. Using immunohistochemistry, the p53 expression was determined. A p53 overexpression is defined as positive staining in 10% or more of the tumor cells.. Among 30 examined cases of carcinomas associated with inverted papillomas, 4 cases were HPV-positive (13%). P53 overexpression was not shown among the HPV-positive cases, whereas p53 overexpression was seen in 21 of the 24 (88%) examined HPV-negative cases. Among the 5 carcinomas associated with exophytic papillomas, HPV was demonstrated together with p53 overexpression in 3 cases (60%). In addition, one case more was with p53 overexpression.. An inverse relation between HPV and p53 overexpression in sinonasal carcinomas associated with inverted papillomas appears to have been demonstrated. HPV and p53 might also have an etiological role among the carcinomas associated with exophytic papillomas.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Denmark; Female; Humans; Immunoenzyme Techniques; Male; Middle Aged; Nose; Nose Neoplasms; Papilloma; Papilloma, Inverted; Papillomaviridae; Papillomavirus Infections; Paranasal Sinus Neoplasms; Paranasal Sinuses; Polymerase Chain Reaction; Retrospective Studies; Tumor Suppressor Protein p53; Tumor Virus Infections

In the last decade inverted papillomas of the nasal cavity and paranasal sinuses have been observed in increasing numbers, and treatment modalities have ranged from extensive open radical procedures to microinvasive endonasal surgical excision.. To establish criteria for selecting patients for open osteoplastic or endonasal surgery according to clearly defined pathological and clinical data.. In a retrospective study, clinical data of 55 patients treated surgically in the University ENT Clinic Giessen from 1991 to 1998 were analysed. In 33 patients (60%) endonasal excision of the papillomas was carried out and in 22 (40%) osteoplastic lateral rhinotomy or maxillotomy were performed. All histological specimens were revised. Patients were followed up and endoscopically examined until 31 March 1999.. In 22 patients, tumours involving the frontal sinus, maxillary sinus, parts of the frontal skull base and anterior ethmoid, and the orbit were operated on using open osteoplastic procedures, with 4 (18%) recurrences observed. Tumours excised endonasally showed the same recurrence rate: 6 out of 33 (18%). These tumours were smaller in size and localized in the nasal cavity, the middle and posterior parts of the ethmoid involving the sphenoid, and the medio-posterior wall of the maxillary sinus. The functional outcome was excellent for all patients; two patients developed a mucocele. Cancerization was observed in three cases.. In select cases the endonasal microsurgical approach to inverted papillomas has the same good results concerning function and tumour control as osteoplastic open rhinotomy. This method should still be preferred in tumours localized in the frontal sinus, anterior ethmoid. anterior. caudal and lateral parts of the maxillary sinus and beyond the sinuses.

Topics: Craniotomy; Endoscopy; Female; Humans; Male; Microsurgery; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Paranasal Sinuses; Reoperation; Retrospective Studies

Dynamic gadolinium-enhanced MR imaging has been used successfully to identify post-treatment recurrence or postoperative changes in rectal and cervical carcinoma. Our purpose was to evaluate the usefulness of dynamic gadolinium-enhanced MR imaging for distinguishing recurrent inverted papilloma (IP) from postoperative changes.. Fifteen patients with 20 pathologically proved lesions (recurrent IP, 12; fibrosis or granulation tissue, eight) were enrolled in the study. Three observers, blinded to pathologic results, independently evaluated conventional MR images, including T1-weighted (unenhanced and postcontrast), proton-density-weighted, and T2-weighted spin-echo images. Results then were determined by consensus. Dynamic images were obtained using fast spin-echo sequences at 5, 30, 60, 90, 120, 150, 180, and 300 seconds after the injection of gadolinium-diethylene-triamine penta-acetic acid. Time-signal intensity curves of suspected lesions were analyzed by a pharmacokinetic model. The calculated amplitude and tissue distribution time were used to characterize tissue, and their values were displayed as a color-coded overlay.. T2-weighted images yielded a sensitivity of 67%, a specificity of 75%, and an accuracy of 70% in the diagnosis of recurrent IP. Contrast-enhanced T1-weighted images yielded a sensitivity of 75%, a specificity of 50%, and an accuracy of 65%. Pharmacokinetic analysis showed that recurrent IP had faster (distribution time, 41 versus 88 seconds) and higher (amplitude, 2.4 versus 1.2 arbitrary units) enhancement than did fibrosis or granulation tissue. A cut-off of 65 seconds for distribution time and 1.6 units for amplitude yielded a sensitivity of 100% and a specificity of 100% for diagnosing recurrent IP.. Dynamic MR imaging can differentiate accurately recurrent IP from postoperative changes and seems to be a valuable diagnostic tool.

Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Paranasal Sinuses; Postoperative Complications; Sensitivity and Specificity

Inverted papilloma is a rare benign tumor of the nose and the paranasal sinuses. There is a controversial discussion concerning the operative approach. The epidemiology, postoperative results, and recurrence rates of endonasally and extranasally operated patients are analysed.. Between 1984 and 1995, 25 patients with inverted papilloma were operated upon at the ENT Department St. Gallen, 18 patients by an endonasal microscopic approach, two by midfacial degloving and five through a lateral rhinotomy.. After a minimal follow-up of 12 months (mean follow-up 52 months), a recurrence rate of 29% for the external approach and 31% for the endonasal approach was observed.. In most cases it is possible to achieve a good result through an endonasal approach. External approaches are recommended in T4-tumors or carcinomas. A longtime follow-up is recommended for each case.

Topics: Adult; Aged; Aged, 80 and over; DNA Probes, HPV; Endoscopy; Female; Follow-Up Studies; Humans; Male; Microsurgery; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Paranasal Sinuses

Inverted papilloma is a benign sinunasal tumor, characterized by aggressive nature and tendency to recur. This tumor also has a significant malignant potential (10%). In spite of extensive research in the past the origin of inverted papilloma is not known.. A retrospective analysis of the clinical data of 28 patients suffering from inverted papilloma of the nose and paranasal sinuses with regard to symptoms, clinical examination, computed tomography findings, and operative management was performed. Furthermore, immunohistochemical examinations of the cytokeratin profile of 12 specimens were carried out.. The most presenting symptoms were unilateral nasal obstruction (17.61%) and rhinorrhea (7.25%). Polyposis was seen endoscopically in 19 cases (68%), so that in many patients in inverted papilloma became suspicious in the CT scan. The surgical therapy was dictated by the extent of the tumor, so that the tumor was treated by lateral rhinotomy (n = 17), midfacial degloving (n = 5), endonasal endoscopic surgery (n = 5), and craniofacial resection due to an infiltration of the frontal skull base (n = 1). An immunohistochemical analysis of the cytokeratin profile revealed for the first time that the inverted papilloma, when compared to the normal surface epithelium of the nasal cavity and the paranasal sinuses, exhibits increased expression of cytokeratin 5, typical for basal cells, and cytokeratin 13, typical for squamous epithelial cells.. Based on our results we recommend that the endonasal approach is reliable for processes restricted to the middle nasal meatus and the anterior and middle ethmoid cells. Inverted papilloma of the frontal sinus, retrobulbar and supraorbital ethmoid cells, and laterocaudal parts of the maxillary sinus should be resected via lateral rhinotomy or midfacial degloving. The findings of immunohistochemical examinations suggest that inverted papilloma is derived from a cytokeratin 5-immunoreactive cell of the basal layer of the mucosa.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Endoscopy; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Middle Aged; Neoplasm Invasiveness; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Paranasal Sinuses; Tomography, X-Ray Computed

The sphenoid sinus has traditionally been considered a poorly accessible structure, situated deep in the center of the head and surrounded by vital structures. Aggressive benign and malignant tumors are usually considered to be inoperable because of the proximity of such structures, thus precluding the possibility of total extirpation. Using the transfacial-subcranial approach, lesions at this site can be totally excised. Significant tumor-free survival rates can be anticipated.

Topics: Carcinoma, Mucoepidermoid; Carcinoma, Squamous Cell; Cavernous Sinus; Craniotomy; Disease-Free Survival; Ethmoid Sinus; Head and Neck Neoplasms; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Nose; Papilloma, Inverted; Paranasal Sinus Neoplasms; Patient Care Planning; Patient Care Team; Prognosis; Sphenoid Sinus; Survival Rate