Dr. Batra has received research grants from ARS and Medtronic. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Surgical management of frontal sinus inverted papilloma: A systematic review†
Article first published online: 27 MAR 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 6, pages 1205–1209, June 2012
How to Cite
Walgama, E., Ahn, C. and Batra, P. S. (2012), Surgical management of frontal sinus inverted papilloma: A systematic review. The Laryngoscope, 122: 1205–1209. doi: 10.1002/lary.23275
- Issue published online: 1 JUN 2012
- Article first published online: 27 MAR 2012
- Manuscript Accepted: 7 FEB 2012
- Manuscript Revised: 24 JAN 2012
- Manuscript Received: 17 SEP 2011
- Inverted papilloma;
- sinonasal papilloma;
- frontal sinus;
- osteoplastic flap;
- endoscopic modified Lothrop;
- endoscopic frontal trephination;
- endoscopic tumor resection;
- Level of Evidence: 3a
Surgical management of frontal sinus (FS) inverted papilloma (IP) remains a significant challenge. This study systematically reviews the FS IP literature to delineate outcomes based on surgical strategy.
Cases for inclusion were identified by literature query for the terms frontal sinus and inverted papilloma between 1995 and 2010. Cases reported with sufficient outcomes data, defined as specific surgical approach and disease-free follow-up, were included. Statistical analysis was performed to identify significant risk factors for recurrence. The reported length of follow-up for each surgical approach was analyzed as an indicator of the strength of the reported literature for each approach.
Fifty-seven cases were identified in 13 studies, with 49 cases deemed adequate for additional analysis. Twenty-four cases (49%) were primary, and 25 (51%) were secondary (residual or recurrent disease) IP. Bilateral FS involvement was reported in eight cases (16.3%). Surgical approaches employed included endoscopic frontal sinusotomy (EFS) in 21 (42.9%), endoscopic modified Lothrop (EML) in 10 (20.4%), osteoplastic flap in 13 (26.5%), and endoscopic trephination and EFS in five (10.2%) patients. The overall rate of recurrence was 22.4%. Mean follow-up time was 27 months.
The recent reported literature of FS IP demonstrates high prevalence of recurrent and bilateral cases. Although statistical analysis of this accrued data is unable to delineate the best surgical approach for FS IP, more aggressive approaches frequently employed for secondary or bilateral disease may facilitate better disease control.