--
Any idea of where I can find information on an 'Inverting Papilloma'. Surgery has been recomended.
Answer ------
Inverting papillomas are uncommon or rare benign tumors that typically occur in the lining of the nose or sinus.
The most common presenting symptom is simply nasal airway obstruction, usually one-sided. Other symptoms may include pain or pressure, nose bleeds, or nasal drainage. More advanced tumors may also cause proptosis (outward displacement of the eye), tear duct obstruction, or facial numbness.
The physical examination reveals a nasal polyp, usually just on one side of the nose. Inverting papillomas tend to have a characteristic appearance, typically a granular mulberry-like mass, that distinguishes it from the more common inflammatory nasal polyp. The inverting papilloma most often originates on the lateral wall of the nasal passage, or in other words, the wall that separates the nasal passage from cheek sinus (maxillary). They may however, occur in other locations in the nose and sinus.
The evaluation may include an x-ray known as a CT scan which will typically reveal a unilateral nasal mass with or without localized bone erosion. A biopsy is necessary to confirm the diagnosis. Microscopic evaluation is diagnostic and reveals tumor cells that tend to invaginate into the surrounding tissue and bone, thus its name - inverting papilloma.
The cause of inverting papilloma has not been identified. Recent studies have suggested some association with the human papilloma virus. Various reviews of inverting papilloma suggest that there is a 5-15% incidence of malignant degeneration.
Presently there are no medications or other non-surgical treatments for inverting papillomas. Radiation is also not generally recommended and in fact there has been some concern raised that radiation therapy may cause malignant degeneration. Surgery is the only available treatment and is generally recommended in all patients unless other more serious medical conditions exist to contraindicate surgery.
There are several surgical approaches to the treatment of inverting papillomas. Often the initial surgical procedure is a nasal polypectomy for the purpose of tissue diagnosis. After the diagnosis has been determined, a surgical approach designed to remove the entire tumor as well as some of the surrounding bone to which the tumor is attached is recommended. The two most widely utilized approaches involve either an incision along the fold between the nose and the cheek on the side of the tumor; or a combination of incisions made under the upper lips and just inside the nostrils which allow the skin of the nose to be lifted off of the underlying bone and cartilage structures, thus sparing any visible incision on the face.
A more recently described approach involves the use of endoscopes without any incisions although this technique presently is reserved generally for small and well-localized tumors.
Unfortunately, due to the tendency of this tumor to infold into surrounding bone microscopically, there is a fairly high incidence of recurrence. The reported rates of recurrence tend to be highest with limited procedures that do not involve removal of a portion of the bone separating the nasal passage from the cheek sinus. Even with the recommended procedure, known as a medial maxillectomy, recurrence rates have been reported as high as 14%.
A more thorough medical discussion of inverting papillomas may be found on the internet at the Baylor College of Medicine's Department of Otolaryngology Web site - http://www.bcm.tcm.edu/oto/ Look in The Grand Rounds Archive under "Rhinology".
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review
previous Ear, Nose and Throat Clinic consultations