Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Laryngoscope. 2009 Dec;119(12):2466-71. doi: 10.1002/lary.20718.
Inverted papilloma (IP) of the sphenoid sinus is a rare neoplasm with a nonspecific and insidious presentation that is further complicated by difficult access for assessment and follow-up. In conjunction with a systematic review of the English literature, we review our experience with IP of the sphenoid sinus to better delineate the clinical presentation, prevalence, management, and recurrence of this challenging lesion.
A systematic search strategy was developed to assess and summarize the best available evidence on sphenoid IP. A retrospective chart review of the 5-year database of one tertiary care Otolaryngology-Head and Neck Surgery practice was performed; all patients with histologically confirmed IP of the nasal cavity or paranasal sinuses were included.
Seventy-one patients (49 males, 22 females; mean age, 57.2 years) treated between June 2003 and January 2009 were included. Nine patients were diagnosed with IP originating in the sphenoid sinus. Two of these patients were asymptomatic, and in the remaining seven patients the most common presentation was headache (42.9%), followed by visual disturbances, hearing loss, and nasal obstruction (28.6% each). Review of the literature confirms our finding that the most common presenting symptom is headache (45.0%), followed by nasal obstruction (30.0%) and epistaxis (22.5%).
This is the largest reported series of sphenoid sinus IP in the English literature. We have demonstrated a predominance of neurological and visual symptoms in symptomatic patients with sphenoid IP, and suggest that these may be early manifestations of sphenoid IP, before the more common sinonasal symptoms develop secondary to extension into the nasal cavity and paranasal sinuses.
蝶窦内翻性乳头状瘤（IP）是一种罕见的肿瘤，其表现具有非特异性和隐匿性，并且由于评估和随访的难度较大而变得更加复杂。我们结合对英文文献的系统回顾，回顾了我们在蝶窦内翻性乳头状瘤方面的经验，以更好地描绘出这种具有挑战性病变的临床表现、患病率、处理方法和复发情况。
制定了系统的搜索策略，以评估和总结有关鼻腔或鼻窦内翻性乳头状瘤的最佳现有证据。对一家三级保健耳鼻喉科-头颈外科实践的 5 年数据库进行了回顾性图表审查；所有经组织学证实的鼻腔或副鼻窦内翻性乳头状瘤患者均包括在内。
共纳入 71 例患者（49 例男性，22 例女性；平均年龄 57.2 岁），这些患者在 2003 年 6 月至 2009 年 1 月间接受了治疗。9 例患者被诊断为起源于蝶窦的内翻性乳头状瘤。这 2 例患者无症状，而其余 7 例患者最常见的表现为头痛（42.9%），其次是视觉障碍、听力损失和鼻塞（各占 28.6%）。文献回顾证实了我们的发现，即最常见的首发症状是头痛（45.0%），其次是鼻塞（30.0%）和鼻出血（22.5%）。
这是英文文献中报道的最大的蝶窦内翻性乳头状瘤系列。我们已经证明了在有症状的蝶窦内翻性乳头状瘤患者中，神经和视觉症状占主导地位，并且提示这些可能是蝶窦内翻性乳头状瘤的早期表现，在更常见的鼻和鼻窦症状因向鼻腔和副鼻窦扩展而出现之前。
