I underwent a right medial maxillectomy, degloving procedure, in 1990.
This included removal of the underlying bone. Again, in 1992, another
degloving procedure was performed for recurrent papilloma. Once again,
in 1993, for suspected recurrence (abcess). I went symptom free until
mid 1995 when I began having constant infections of the sinus cavity and
tear duct blockage. A CT scan was performed but papilloma not diagnosed.
I underwent tear duct surgery in Nov. 1995 for a blocked tear duct (it
was redirected at the bridge of my nose).
Recently, I have been having problems with dizziness with
tingling/numbness in my left arm (after a mild concussion in April) and
had an EEG performed as well as an MRI. They were normal for hematoma
and seizure activity. However, the MRI report states that it shows
papilloma. Since then (10 days later) am currently in a severe
infectious state with discharge oozing from my right eye (This developed
within the last 24 hr. period) and am on antibiotics.
I have been referred to OHSU Medical School and would like your opinion.
What are my chances of this being a malignant invasion this time and
your prognosis for treatment? I am 42 years old. Is another degloving
procedure recommended or a more invasive (external) one, and radiation
follow-up? Any other information you can give me will be greatly
appreciated.
Thank you.
Reply -------------------
I have previously posted a discussion of this topic which provides some
general information about this - please refer to the heading "inverting
papilloma".
To specifically answer your questions, the risk of malignancy has been
reported to be between 5-15%. The fact that the papilloma has apparently
recurred is not by itself suggestive of a malignant process. The recurrence
rates of inverting papilloma following surgical removal are reduced with
surgical approaches that involve a medial maxillectomy. Medial
maxillectomies can be performed either by an external approach known as a
lateral rhinotomy, or by a more internal approach known as a midfacial
degloving procedure in which the incisions are not made on the skin of the
face. However, recurrence rates have been reported as high as 14%.
Radiation therapy in the treatment of inverting papillomas is generally
not recommended because of fear of malignant transformation. However, there
may be some role for radiation therapy in certain cases where the papillomas
have become less surgically accessible as in intracranial extension.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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