Endoscopic medial maxillectomy for inverted papillomas of the paranasal sinuses: Value of the intraoperative endoscopic examination

Objective: The extent of paranasal sinus involvement by inverted papilloma and the degree of surgery are often determined before surgery by computer tomography (CT), The sensitivity and specificity of preoperative CT versus intraoperative endoscopic examination are unknown. Study Design: Prospective. Methods: Nineteen patients with inverted papilloma who underwent endoscopic medial maxillectomy were staged tomographically, Findings were compared with pathological and intraoperative endoscopic findings. Results: Twenty sides were evaluated. The overall sensitivity and specificity for the preoperative CT evaluation were 69% and 20%, respectively. For intraoperative endoscopic evaluation they were 69% and 68%, respectively, Excluding the sphenoid sinus, the overall sensitivity for CT scan and intraoperative endoscopic evaluation increased to 87%, Excluding the anterior ethmoids, the overall specificity for CT scan and intraoperative endoscopic evaluation increased to 25% and 79%, respectively. The overall cure rate was 94% (18 patients) with an average follow-up of 36 months (range, 16-80 mo). Conclusion: Intraoperative endoscopic examination is comparable in sensitivity but better in specificity than preoperative CT analysis for differentiating between inverted papilloma and other disease. Both modalities of evaluation tend to overestimate the extent of disease (sensitivity), The presence of a normal intraoperative endoscopic examination may be a better way of determining the extent of mucosal removal during surgery. Endoscopic medial maxillectomy remains an effective surgical option for inverted papilloma removal.