Investing papilloma maxillary sinus polyp

investing papilloma maxillary sinus polyp

INDEX TERMS Deep learning, inverted papilloma, nasal polyp, pre-classify, turbinate, or ethmoid recess [2], often signaled by maxillary. Those polyps that arise in the maxillary antrum and extend into the middle Sinonasal polyps and papillomas, as well as coccidiomycosis Lab Invest. 1. Snyder R.N., Puzim K.H. Papillomatosis of nasal cavity and paranasal sinuses. Cancer –, 2. Esclamado R.M. Squamous cell carcinoma arising. CSGO LOUNGE BETTING RULES IN POKER

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The Krouse staging system was used to evaluate the IP status [ 13 ]. The excised tissue was evaluated through postoperative pathologic examination and confirmed as an IP; dysplasia in the excised tissue was also assessed. Patients with concomitant squamous cell carcinoma were excluded. This study was performed in accordance with the Declaration of Helsinki.

Expanded Endoscopic Approaches Endoscopic medial maxillectomy can be performed in the usual fashion [ 3 ] by resecting medial wall of the MS, including the inferior turbinate and the nasolacrimal duct. A modified EMM can be performed, preserving the inferior turbinate. This is accomplished by maintaining the posterior attachment during resection of the IP in the MS and suturing the anterior end to the lateral wall at the conclusion of the surgery Figure 1.

For the prelacrimal recess approach, a curved incision is performed immediately posterior to the mucocutaneous junction, from the lateral wall of the nasal cavity to the nasal floor Figure 2 A. The mucoperiosteum is carefully elevated, identifying the following structures: bony pyriform aperture, lateral wall, anterior end of the IT, inferior meatus, and nasal floor Figure 2 B. A prelacrimal bone osteotomy is performed in the lateral wall with a straight 3 mm osteotome between the pyriform aperture and the IT attachment Figure 2 C.

The NLD can be further exposed by partial removal of the bony lateral wall. A temporary suture of the lateral wall flap facilitates subsequent instrumentation passage through this corridor. The corridor can be enlarged posteriorly to the MS posterior wall, superiorly to the lacrimal sac, and inferiorly to the nasal floor.

The lateral nasal wall can be removed up to the pyriform aperture to reach the anterior and lateral walls of the MS. The tumor in the MS is debulked, isolating the attachment site Figure 2 G,H , which is resected with 1 cm margins using a multilayer centripetal technique Figure 2 I. The hyperostotic attachment site is usually drilled with preservation of the posterior periosteum Figure 2 J. Patients typically present with complaints similar to chronic rhinosinusitis including nasal congestion, purulent drainage, headaches and postnasal drip.

It is not uncommon to be initially treated for a sinus infection multiple times before an evaluation by a specialist. An otolaryngologist will often have a clinical suspicion based on an in office nasal endoscopy but diagnosis cannot be confirmed without a biopsy which can generally be done in the office.

In addition a CT scan is done to confirm the presence of a mass and evaluate the size and paranasal sinus involvement. Other areas of concern are segments of missing or eroded bone on the CT scan, or dehiscent bone along the eye or skull base adjacent to the brain. In some situations MRIs are also performed to evaluate extent of tumor extending beyond the paranasal sinuses into the eye or brain or if further characterization is necessary to evaluation the size of the tumor and give clues as to whether any malignant transformation has occurred.

The mainstay of treatment for inverted papilloma is surgery. It is important to go to an experienced surgeon as if not removed completely, inverted papilloma has a high rate of recurrence. Surgical resection is typically performed endoscopically with any areas of tumor attachment to surrounding paranasal sinus bone requiring drilling down of the bone to prevent recurrence.

If any concerning features for squamous cell carcinoma are seen on review of the operative pathology, patients may need a wider resection or additional treatments such as chemotherapy or radiation therapy. Case Examples Case Example 1: A year-old male presented to an outside otolaryngologist for headaches.

He was initially taken in for balloon sinuplasty and removal of a polyp on the right side. Pathology of the polyp came back as inverted papilloma and the patient was sent to a university hospital for management. On examination the patient has an inverted papilloma in the right nasal cavity with a CT scan demonstrating an attachment of the bone along the skull base Image 1.

MRI confirmed the mass did not go into the frontal sinus itself Image 2 and his headaches where likely related to trapped fluid in the frontal sinus from obstruction due to the inverted papilloma. See video for surgical resection. He is approximately 2 years out from surgery without evidence of recurrence. Given the location of the inverted papilloma a simple endoscopic evaluation in the office is all that is necessary to confirm no tumor recurrence.

Due to the high risk of recurrence of inverted papilloma, long-term follow up is necessary. Typically follow CT scan or MRI is not necessary as long as the area can be seen clearly by endoscopy.