Inverted Papilloma

Inverted papilloma


     Inverted papilloma (IP) is a rare benign tumor which occurs in the nasal sinus cavities, characterized by its potential for recurrence, malignant transformation and the possible association with a squamous cell carcinoma.

     Study Objectives: To analyze a literature review the clinical, radiological, therapeutic and evolution this condition.

     Material and Methods: A retrospective study of 19 cases of inverted papillomas treated in the department of ENT and Head and Neck Surgery, CHU Saint Etienne, during a period of 7 years (1 / 1996 - 1 / 2003).

     Results: Our patients are 15 males and 4 females with a average age of 52.5 years (24-65 years). A history of nasal sinus surgery was found in 5 patients, 4 patients are polyposis allergic and nasal sinus in 1 case. In 1 case, there was a recurrence of inverted papilloma treated 12 years ago. The most common symptom was nasal obstruction in 13 cases, 5 cases in rhino rhea, headache in 1 case. In 3 cases, the discovery was fortuitous. It was a ethmoido maxillary sinusitis in 4 cases, a polyp of the right nasal pit (FN) in 1 case, 1 case in the nasal pharynx, one case presented a swelling in the nasal threshold in a case of bilateral sinus polyposis out of 4 cases, a diffuse involvement of the paranasal sinuses in 4 cases.

     All patients were operated: one by endonasal ethmoidectomy was performed in 15 cases, associated with a mini-Caldwell-Luc in 5 cases. Resection of polyp through endoscopy was made in 2 cases of inverted papilloma. A resection of the tumor threshold nostril was performed by means of Degloving. The diagnosis was confirmed by histology in all cases. The evolution was marked by a recurrence in 2 cases, 2 months and 2 years. It was favorable in other cases with a mean of 39 months. Conclusion: The inverted papilloma is a benign tumor with a potential for recurrence and degeneration. A complete resection most often by endoscopy is recommended and a strict surveillance in the long term.

     The inverted papilloma is a rare tumor with an appearance rate between 0.5 to 4% of tumors of the nose (possibly viral origin), its evolution is slow, it affects human.

     This tumor can lead to cancer in 5 to 13% of cases.

     At the beginning stage results in an obstruction (blocked nose) to one side, less often, pain and bleeding. Endoscopic examination of the polyps found irregular surface of one side. The scanner confirms the attainment of sinus and bone destruction. The treatment is surgical, it will be preceded by a biopsy to confirm the diagnosis and eliminate a cancer of the sinuses. Surgery should be broad and comprehensive in order to avoid recurrence.




THE SENTINEL OF POLYP OF SINUS CANCER


     A polyp can hide a banal sinus cancer beginner, the character hemorrhagic polyp, bleeding and pain should raise the suspicion of cancer of the sinuses (rare lesion).

     A sinus CT and MRI will improve the diagnosis.

     A biopsy under general anesthesia will confirm cancer.

     The Mucosis(cyst of the sinuses)

     The mucosis are cystic lesions developed from the sinus mucosa. They are formed as a result of a blockage of sinus drainage (often traumatic or post-surgical).

     The contents of these cysts are fluid, they gradually lead to massive destruction of bony structures at the origin of complications can be serious. They can be located either on the maxillary sinus, ethmoid, frontal or sphenoidal giving symptoms vary.

     At an advanced stage, they grow under the skin causing strain on the forehead and orbit. The diagnosis relies on imaging: CT and MRI of the sinuses. The treatment is surgical.