A Study On The Clinical Profile And Management Of Inverted Papilloma

摘要

Inverted papilloma is a locally aggressive sinonasal tumor that arises from the outlining Schneiderian respiratory membrane. The present study was carried out in the department of otorhinolaryngology of Nepalgunj medical college during March 2004 to 2008. 25 patients with inverted papilloma admitted in the department were included in the study A detailed history, ENT and detailed radiological evaluation by contrast CT scanning was done taking coronal and axial cuts of nose and PNS. Endoscopic examination and biopsy performed to confirm the diagnosis before going in for definitive surgical treatment. Depending upon the site, size and invasion the surgery planned included lateral rhinotomy, medial maxillectomy, endoscopic ethmoidectomy. Patients were followed up for average 2 years. Data regarding the clinical features, investigations and surgical approach were collected and compared to the existing studies. This study showed that inspite of geographical diversity and late presentation of the patient, recurrence rate was low. Introduction Inverted papilloma is a locally aggressive sinonasal tumor that arises from the outlining Schneiderian respiratory membrane. Ward reported the first case of inverted papilloma in 1864. It is a relatively rare neoplasm, constituting 0.5% to 4% of all primary nasal tumors. It has been reported in all age groups, peak incidence being in the fifth and sixth decades of life. There is a male to female predominance in the ratio of 3 to 1. Caucasians are more commonly affected. The etiology of this tumor is unknown. Possible theories include proliferation of nasal polyp, allergy, chronic inflammation, environmental carcinogens, and viral infection. Using the techniques of southern blot molecular hybridization, Respler recently reported the presence of human papilloma virus (HPV) type 11. In Weber's study, all recurrent inverted papilloma were HPV DNA positive, suggesting that the presence of the virus may affect the biological behavior of these epithelial proliferations. Further analysis is needed to confirm that HPV is not only a bystander.Currently endoscopic removal of tumour is gaining popularity but incidence of recurrence is quite high. The surgical technique of choice is an en bloc medial maxillectomy and ethmoidectomy as described by Sessions (1977). This provides complete visual delineation of all tumor margins while preserving the orbital rim, eye, nasal pyramid, and lacrimal apparatus. The medial maxillectomy can be accomplished via either lateral rhinotomy or mid-facial degloving techniques.Aims & objective To review our experience in the management of inverted papilloma in this institute To emphasize the role of intraoperative nasal endoscopy in the management of inverted papilloma Material & Method Present study was carried out in the department of otorhinolaryngology of Nepalgunj medical college during march 2004 to 2008. 25 patients with inverted papilloma admitted in the department were included in the study. A detailed history regarding onset and duration of symptoms previous surgery and history about prior chronic rhinosinusitis were noted. ENT examination done as anterior and posterior rhinoscopy. Detailed radiological evaluation by contrast CT scanning was done taking coronal and axial cuts of nose and PNS. Endoscopic examination and biopsy performed to confirm the diagnosis before going in for definitive surgical treatment. Depending upon the site, size and invasion the surgery planned included lateral rhinotomy, medial maxillectomy, endoscopic ethmoidectomy. Intraoperative nasal endoscopy done in every case to ensure the extent of excision in order to excise the whole pathology with normal margin to prevent recurrence. Patients who showed malignant changes were sent for radiation therapy using CO60. Results The age of the patients ranged from 13-65 years with a mean age of 39 years. The maximum number of patients 12(60%) were found in the age group of 51-70 years. Males were 18(7