Sphenoid Sinus Inverted Papilloma: A Rare Presentation and Treatment Challenges

Authors: Juan Dib J , Long FF , Marinelli S and Carlos Santiago Ruggeri*

DOI: 10.23880/ooaj-16000304

Volume 10, Issue 1

Abstract

Inverted papilloma is a benign tumor that can undergo synchronous or metachronous malignant transformation. Its isolated location in the sphenoid sinus is rare and its surgical treatment is challenging due to the anatomical variants that may exist and the nervous and vascular structures that are related to this sinus. Objectives: To determine the local control rate in inverted papillomas and synchronous carcinomas with inverted papilloma located in the sphenoid sinus, and to describe the surgical technique for inverted papillomas according to the anatomical characteristics of the sphenoid. Methods: Patients who were evaluated and treated for inverted papillomas primarily located in the sphenoid sinus from 2002 to 2023 in the Rhinosinusology and Skull Base Section of the ENT Department at the Hospital Italiano de Buenos Aires were included. A nasal corridor was created by resecting the middle turbinate in some patients, and anterior and posterior ethmoidectomies with unilateral maxillary antrostomy were performed, choosing the most affected nasal cavity by the tumor. Next, a posterior septectomy was done to expose the entire sphenoid from one nasal fossa. The inverted papilloma was then resected, starting from the center to induce a central collapse, followed by excision of the lateral remnants in contact with the carotid artery and optic nerve. In patients with sphenoid sinuses with pneumatization of the pterygoid processes and highly developed lateral recesses, the trans-pterygoid endonasal approach was combined with sphenoidotomy In inverted papillomas with synchronous squamous carcinomas, treatment with cisplatin and intensity-modulated radiation therapy (IMRT) was associated with the biopsy or debulking. Follow-up was performed through nasal endoscopy magnetic resonance imagen. Results: Six patients were treated: five males and one female, with inverted papillomas mainly located in the sphenoid sinus. Two of them had synchronous squamous carcinomas. In one patient, subtotal resection was performed as the intraoperative biopsy was reported as inflammatory tissue. After the final diagnosis of inverted papilloma, the patient refused further surgery The final local control rate we achieved in three patients treated through endonasal approaches with endoscopes for curative purposes was 66.66%. Local control in synchronous carcinomas with inverted papilloma staged as T4-b was 50%. Conclusions: The final local control rate we achieved in three patients treated through endonasal approaches with endoscopes for curative purposes was 66.66%. Local control in synchronous carcinomas with inverted papilloma staged as T4-b was 50%. The main endonasal technique is wide paraseptal sphenoidotomy. We prefer to perform a central resection of the tumor and then dissect the lateral walls of the sinus. In cases of extensive pneumatization of the sphenoid and the presence of lateral recesses, we believe it is better to combine sphenoidotomy with a trans-pterygoid approach.

Keywords: Inverted Papilloma, Sphenoid Sinus, Endoscopic Surgery, Transpterygoid Approach

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