School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
J Otolaryngol Head Neck Surg. 2018 Apr 4;47(1):24. doi: 10.1186/s40463-018-0271-1.
Inverted papillomas (IPs) are benign neoplasms, most commonly arising from the mucosal lining of the maxillary sinus. IPs can have single or multifocal sites of attachment. Although pedicle location is an important factor to consider in surgical planning, it is less clear whether the location or number of IP attachment sites hold any prognostic value. Herein, we aimed to determine the prognostic significance of the number and location of attachment sites of IPs originating from the maxillary sinus when managed by a pure endoscopic approach.
This was a single-center, single-surgeon retrospective chart review. Patients with maxillary sinus IPs who were managed by endoscopic approaches only, from January 1, 2010 to June 30, 2016, were identified. Demographic data, operative technique, number and location of IP attachment sites, follow-up duration, recurrence, and presence of malignant transformation were captured.
Twenty-eight maxillary IP patients (61% males) were included, with a mean age of 54.9 (standard deviation (SD): 16.5) years. Approximately 36% of patients were referred from other institutions for management of recurrent IPs after failing previous surgical treatment. All patients were managed with an endoscopic approach, and all required an endoscopic medial maxillectomy to facilitate access to the maxillary sinus. At a mean follow-up of 31.1 (SD: 22.6) months, there were no recurrences identified. IPs with single (46%) and multifocal (54%) attachments were predominately to the medial and lateral walls. Maxillary IPs with multifocal attachments most frequently involved 2-3 walls of the sinus. Osteitis (36%) was commonly seen.
IPs originating from the maxillary sinus frequently had multifocal attachments, but this did not impact disease recurrence. Despite the surgical challenges of accessing all of the maxillary sinus walls, IPs originating from the maxillary sinus can be effectively managed via a pure endoscopic approach.
内翻性乳头状瘤（IP）是良性肿瘤，最常发生于上颌窦的黏膜内层。IP 可以有单一或多个附着部位。虽然蒂部位置是手术规划中需要考虑的重要因素，但 IP 附着部位的位置或数量是否具有预后价值尚不清楚。在此，我们旨在确定经单纯内镜处理的上颌窦起源的 IP 数量和附着部位位置的预后意义。
这是一项单中心、单外科医生回顾性图表研究。确定了 2010 年 1 月 1 日至 2016 年 6 月 30 日期间仅通过内镜方法治疗的上颌窦 IP 患者。收集了人口统计学数据、手术技术、IP 附着部位的数量和位置、随访时间、复发和恶性转化的存在。
共纳入 28 例上颌 IP 患者（61%为男性），平均年龄为 54.9（标准差（SD）：16.5）岁。约 36%的患者因前次手术治疗失败后复发而从其他机构转诊来管理 IP。所有患者均采用内镜方法治疗，均需行内镜内侧上颌窦切除术以方便进入上颌窦。平均随访 31.1（SD：22.6）个月，未发现复发。具有单部位（46%）和多部位（54%）附着的 IP 主要位于内侧壁和外侧壁。具有多部位附着的上颌窦 IP 最常累及窦腔的 2-3 个壁。骨炎（36%）常见。
起源于上颌窦的 IP 常具有多部位附着，但这并不影响疾病复发。尽管进入所有上颌窦壁存在手术挑战，但通过单纯内镜方法可以有效地治疗起源于上颌窦的 IP。
