Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases.

OBJECTIVE: The objective of this study is to compare the surgical options for treatment of inverted papilloma to determine the appropriate indications for conservative and aggressive management.

STUDY DESIGN AND SETTING: A retrospective review of 160 patients with a diagnosis of inverted papilloma treated by the two senior authors (w.l. and h.f.b.) between 1973 and 2001.

RESULTS: The study group consisted of 124 male and 36 female patients with an average age of 56 years. The follow-up period ranged from 10 months to 16 years (mean, 5.2 years). Seventy-eight patients (49%) had undergone prior surgery. Lateral rhinotomy was performed in 112 patients (70%), with a recurrence rate of 18%. Conservative removal was performed in 41 patients (26%), including 30 (19%) endoscopic approaches, with a recurrence rate of 12%. The remaining patients underwent midfacial degloving, osteoplastic approach, or craniofacial resection. The rate of malignant transformation was 7%.

CONCLUSION: We present the largest personal series of cases of inverted papilloma to date. Our data suggest that conservative approaches, especially endoscopic removal, can be performed on selected lesions with recurrence rates that are comparable to those of more aggressive techniques. Those inverted papillomas that recur after treatment may represent a subset of lesions with an inherent aggressiveness, for which optimal treatment has yet to be determined.