Selection Of Secondary Surgical Approaches For Recurrent Nasal Inverted Papilloma

Objective:Nasal inverted papilloma (NIP) is one of epithelium tumors, which originate in the cavum nasi and paranasal sinus. The incidence of NIP is about0.03%-0.8%, accounting for around0.5%-4%of rhino tumors. With characteristics of local invasive growth and high recurrence rate and malignancy rate, NIP is always treated as malignancy clinically. Although surgical operation offers an optimum option for nasal inverted papilloma, the postoperative recurrence rate has been relatively high. The best therapy for recurrent nasal inverted papilloma is a secondary surgical operation, matters whether the tumor should be completely resected immediately so as to avoid next recurrence effectively. This study aims to discuss about the association between the selection of a secondary surgical approach and a postoperative recurrence, in order to improve the levels of diagnosis and treatment.Materials and Methods:This retrospective study included31postoperative recurrent cases of NIP (a total of165cases) from April1996to August2011admitted to Zhejiang University affiliated Sir Run Run Shaw Hospital. We analyzed the selection of secondary surgical approaches and follow-up data. Results:Among31cases followed up completely, the selection of secondary surgical approaches was listed as follows:8cases (8/31,25.8%) had the endoscopic sinus surgery (Surgical-1),7cases (7/31,22.6%) had the endoscopic with Caldwell-Luc technique (Surgical-2),14cases (14/31,45.2%) had the endoscopic with lateral rhinotomy approach (Surgical-3) and the remaining2cases (2/31,6.5%) had the endoscopic with median plane by overturn approach (Surgical-4): Among11(11/31,35.5%) recurrent cases after the secondary surgical operation,5cases used Surgical-1,4cases used Surgical-2,2cases employed Surgical-3and none of Surgical-4.Conclusion:The best treatment for NIP is surgical operation, which focuses on the regulating the tumor in the first surgery, to the point where infraocular tumor-free is significant. However, one should be prudent towards the selection of surgical approaches for recurrent cases. Clear and broad visual fields are the key points for the success of the secondary surgery. We consider that the endoscopic surgery with lateral rhinotomy approach is a good choice and worth further investigating in clinical practice.