Ebihara Teru, Omura Kazuhiro, Fukuzato Soichiro, Fukasawa Nei, Otori Nobuyoshi
Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, JPN.
Department of Pathology, The Jikei University School of Medicine, Tokyo, JPN.
Cureus. 2025 Feb 5;17(2):e78586. doi: 10.7759/cureus.78586. eCollection 2025 Feb.
The postoperative recurrence rate of sinonasal inverted papilloma (IP) is high, and the residual tumor at the attachment site (the pedicle of the tumor) is considered the main cause of recurrence. Therefore, a surgical approach tailored to the tumor attachment is crucial. Localized hyperostosis is an imaging characteristic of the attachment observed on computed tomography (CT). This study aimed to determine the tendency of hyperostosis at the IP attachment location according to the detailed anatomical site and to improve the prediction accuracy of the preoperative attachment site.
This single-center retrospective cohort study was conducted at the Jikei University Hospital from April 2018 to March 2024, targeting patients diagnosed with IP. The attachment distribution and details of the hyperostosis at the attachment on CT were investigated.
Among the 127 included patients, the attachments were identified in the nasal septum (n=3), ethmoid sinus (n=51), maxillary sinus (n=59), frontal sinus (n=8), sphenoid sinus (n=5), and multiple or broad attachments (n=1). Hyperostosis was observed in all cases of the skull base, uncinate process, infraorbital wall, posterior wall, floor of the maxillary sinus, and floor of the sphenoid sinus. In contrast, non-hyperostosis was observed in all cases of the nasal septum, supraorbital cell, anterior wall of the maxillary sinus, and posterior wall of the sphenoid sinus.
This study revealed significant hyperostosis in the posterior wall of the maxillary sinus, infraorbital wall, skull base, uncinate process, and floor of the sphenoid sinus, whereas the infraorbital wall, posterior wall, floor of the maxillary sinus, skull base, uncinate process, and floor of the sphenoid sinus exhibited significant bone hyperostosis. These findings can lead to improved accuracy of preoperative attachment prediction using CT, appropriate surgical approach selection, and better explanations for patients, especially in the maxillary sinus and skull base IP.
鼻窦内翻性乳头状瘤（IP）术后复发率较高，肿瘤附着部位（肿瘤蒂部）的残留肿瘤被认为是复发的主要原因。因此，针对肿瘤附着情况量身定制手术入路至关重要。局限性骨质增生是在计算机断层扫描（CT）上观察到的附着部位的影像学特征。本研究旨在根据详细的解剖部位确定IP附着部位骨质增生的倾向，并提高术前附着部位的预测准确性。
本单中心回顾性队列研究于2018年4月至2024年3月在日本庆应义塾大学医院进行，研究对象为确诊为IP的患者。调查了CT上附着部位的附着分布及骨质增生细节。
在纳入的127例患者中，附着部位分别为鼻中隔（n = 3）、筛窦（n = 51）、上颌窦（n = 59）、额窦（n = 8）、蝶窦（n = 5）以及多处或广泛附着（n = 1）。在所有累及颅底、钩突、眶下壁、后壁、上颌窦底壁和蝶窦底壁的病例中均观察到骨质增生。相比之下，在所有累及鼻中隔、眶上筛房、上颌窦前壁和蝶窦后壁的病例中均未观察到骨质增生。
本研究揭示了上颌窦后壁、眶下壁、颅底、钩突和蝶窦底壁存在明显骨质增生，而眶下壁、后壁、上颌窦底壁、颅底、钩突和蝶窦底壁表现出明显的骨质增生。这些发现有助于提高使用CT进行术前附着部位预测的准确性、选择合适的手术入路，并能更好地向患者解释病情，尤其是在上颌窦和颅底IP的情况下。
