ABSTRACT
BACKGROUND: The purpose of this study was to define the optimal surgical strategy for sinonasal inverted papilloma in relation to the site of origin and tumor extent. METHODS: Retrospective analysis of patients affected by inverted papilloma treated by purely endoscopic or combined approaches at the Department of Otorhinolaryngology of the University of Brescia and Pavia-Varese from November 1991 to December 2007. RESULTS: Two hundred twelve patients were considered eligible for this study. An exclusive endoscopic approach was performed in 198 patients (93.4%); the remaining 14 patients (6.6%) underwent an endoscopic approach combined with an osteoplastic frontal flap. Follow-up ranged from 24 to 192 months (mean, 53.8 months). A single recurrence was observed in 12 patients (5.7%). Twenty complications (9.4%) were observed. CONCLUSION: Endoscopic surgery is the first choice in the treatment of inverted papilloma; only lesions with extensive involvement of frontal sinus and/or supraorbital cell may require a combined approach. A minimum follow-up of 5 years is recommended.
Subject(s)
Endoscopy/methods , Otorhinolaryngologic Surgical Procedures/methods , Papilloma, Inverted/surgery , Paranasal Sinus Neoplasms/surgery , Surgical Flaps , Adult , Aged, 80 and over , Analysis of Variance , Biopsy, Needle , Cohort Studies , Endoscopy/adverse effects , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Otorhinolaryngologic Surgical Procedures/adverse effects , Papilloma, Inverted/pathology , Paranasal Sinus Neoplasms/pathology , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Preoperative Care/methods , Plastic Surgery Procedures/methods , Retrospective Studies , Statistics, Nonparametric , Time Factors , Treatment Outcome , Young AdultABSTRACT
Different traditional surgical approaches, such as transcervical, transparotid, and mandible-splitting procedures, have been described to expose the retropharyngeal space. The introduction of the transoral approach, in selected patients, provided a direct and adequate access to the retropharyngeal space, permitting a feasible and minimally invasive procedure to remove retropharyngeal lymph nodes. We report a case of a transoral video-assisted approach for the excision of a retropharyngeal lymph node in a young man who had previously been treated at another institution by surgery and radiotherapy for oral tongue cancer. The endoscopic magnification allowed us to perform a meticulous and relatively bloodless dissection of the lesion from the surrounding tissues with a clear identification of the anatomic structures, and therefore may represent a valid alternative to the use of a microscope or loupes to enhance vision. A clear understanding of the anatomy of the retropharyngeal space and a high degree of surgical expertise are required to perform a safe dissection of the lesion.
