Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma

Background: It is well documented that inverted papillomas (IP) have a localized attachment site. Still, instend of concentrating oil the attachment site, endoscopic surgeons often perforin all extended resection similar to the one achieved after external surgery. Objective: Our objective was to evaluate all attachment-oriented endoscopic surgical strategy and to determine IP attachment diameter and location. Methods: A prospective study was conducted. Thirty-three consecutive patients who underwent endoscopic IP excision (2007-2007) were enrolled. Thirty patients had adequate follow-up. Attachment diameters were measured in 25133 patients. Surgery included debulking, identifying file precise mucosal attachment site, subperiosteal dissection and excision of the attachment, frozen section control, and resection/drilling of underlying bone. Results: The mean measured attachment diameter (n = 25) was 8.4 +/- 6 mm (range, 3-23 mm). Attachment locations included maxillary sinus (39%), ethmoid sinus (21%), nasal cavity (21%),frontal sinus (6%), sphenoid sinus (6%), lamina papyracea (3%), and cribriform plate (3%). The mean follow-up (n = 30) was 40 21 months. Three patients had Krouse stage 1, 10 patients had stage 2, and 17 patients had stage 3. Nine patients had undergone previous surgeries. After attachment-oriented endoscopic surgery, three patients had persistent disease, Nasolacrimal duct stenosis was the only complication (n = 1). Conclusion: Even advanced IP have small attachments. Their Identification facilitates efficacious resection with minimal morbidity.