原发性额窦癌三例临床分析

目的 总结诊断和治疗原发性额窦癌的经验与教训.方法 回顾性分析2006-2010年在解放军总医院诊治的3例原发性额窦恶性肿瘤的临床资料.3例均为鳞状细胞癌,其中基底细胞样鳞癌1例,内翻性乳头状瘤癌变(中分化鳞癌)1例,乳头状鳞癌1例.所有病例均通过内镜+额部颅骨切开进路切除肿瘤,手术后给予放疗+化疗.结果 例1放疗结束后半年复查,发现沿发际内冠状切口多发转移癌,遂给予化疗,术后16个月死亡.例2手术后40d(放疗期间)复查,左侧眶内和左侧额窦内上部肿瘤复发,遂行第二次手术(眶内容切除术+肿瘤切除术),第二次术后继续放疗+化疗,3个月后复查,发现骨转移.第一次术后10个月患者死亡.例3手术后出现右侧眶尖综合征,视力丧失.手术+放疗后14个月复查,肿瘤复发,侵犯颅内,患者拒绝再次手术,自动出院,手术后21个月电话随访,患者带瘤生存.结论 原发性额窦恶性肿瘤少见,早期诊断困难.确诊后应积极施行扩大切除术,彻底切除肿瘤,手术后辅助放疗和化疗.原发性额窦恶性肿瘤的预后不佳.     

鼻内翻性乳头状瘤内镜手术治疗

目的探讨鼻内镜切除鼻内翻性乳头状瘤的手术方式。方法回顾分析13例鼻腔鼻窦内翻性乳头状瘤,男10例,女3例,年龄22～67岁。鼻腔来源3例,上颌窦来源3例,筛窦来源2例,额窦及额隐窝区域来源3例,蝶窦来源2例。全部病例均接受鼻内镜手术。结果 13例患者均在鼻内镜下切除,随访6个月～6年未见复发。有1例患者术中发现部分肿瘤恶变,术后接受放疗,随访3年半未见复发。结论根据鼻内翻性乳头状瘤发生及累及部位选择合适手术径路,采取恰当的手术方式,对于有恶变者采取综合治疗,能够提高治愈率,减少复发。     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

鼻腔-鼻窦内翻性乳头状瘤复发与恶变的治疗

目的　探讨鼻腔 鼻窦内翻性乳头状瘤复发与恶变的临床特点与治疗方法。方法　回顾性分析 1990～ 2 0 0 0年我院收治的鼻腔 鼻窦内翻性乳头状瘤复发和恶变患者的临床资料。结果2 2例肿瘤复发患者既往均有鼻腔 鼻窦手术史 ,其中复发 1次者 13例 ,复发 2次者 7例 ,复发 3次者 1例 ,复发 4次者 1例 ,复发时间从 3个月～ 11年。 2 2例中 ,经鼻腔入路 ,经上颌窦根治径路 ,经鼻侧切开径路的复发率分别为 73 3% ,4 2 9%和 33 3% ,10例采用了内镜或内镜辅助手术 ,经随访 1～ 5年 ,未见肿瘤再次复发。 8例肿瘤恶变患者 ,4例接受了鼻侧切开肿瘤切除术 ,1例柯 陆手术 ,手术后均给予放射治疗 (40～ 70Gy) ,这 5例经随访 2～ 6年未见肿瘤复发 ,另外 3例 ,1例失随访 ,2例死亡。结论　积极、彻底的内镜下手术 (包括内镜 +外部切口的联合入路 )是治疗内翻性乳头状瘤 (包括复发肿瘤 )的首选方法 ,对于肿瘤恶变患者应采取广泛手术切除加手术后放射治疗 ,但预后不佳     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

Staged endoscopic and combined open/endoscopic approach in the management of inverted papilloma of the frontal sinus

BACKGROUND: The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined. METHODS: We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004. RESULTS: A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months. CONCLUSION: The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.     

Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy

OBJECTIVES/HYPOTHESIS: Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results. STUDY DESIGN: A prospective study and an integrated literature review. METHODS: Seventeen consecutive patients with inverted papilloma who underwent endoscopic surgical excision, including medial maxillectomies and modified Lothrop procedures, were analyzed. Preoperative symptoms, computed tomography and magnetic resonance imaging findings, operative findings, tumor stage, and outcomes were recorded. RESULTS: Thirteen male and four female patients presented with inverted papilloma between December 1993 and October 2001. Nasal obstruction was the most common presenting symptom (50%). Sixty-five percent of tumors were either stage II or stage III. Endoscopic resection was the primary treatment in 14 patients. Of the three patients who were secondarily treated endoscopically, one had recurrence and was subsequently found to have focus of squamous cell carcinoma. The overall recurrence rate was 6% and the incidence of malignancy was 6% (1 of 17). Recurrence rate for primary resections was zero (0 of 14). Five patients underwent endoscopic medial maxillectomies, and one patient with frontal sinus inverted papilloma was successfully treated with a modified endoscopic Lothrop procedure. CONCLUSIONS: Endoscopic sinus surgery is a viable treatment alternative for sinonasal inverted papilloma. Recurrence rates for primary treatment are comparable to external approaches. Close follow-up of patients is mandatory because recurrence may be associated with malignancy.     

Inverted papilloma involving the frontal sinus: a management plan

Inverted papilloma is a benign but locally aggressive sino-nasal tumour. Although relatively uncommon, involvement of the frontal sinus by this tumour represents a significant surgical challenge. The objective of the study is to propose a scheme for management of inverted papilloma involving the frontal sinus, based upon the findings of the current study. All cases of inverted papilloma operated upon between July 1995 and June 2008 were retrospectively reviewed to identify cases in which the tumour involved the frontal sinus. Among 34 patients with inverted papilloma, 4 were found to have tumours involving the frontal sinus (11.76%). These patients were initially treated by endonasal endoscopic resection. At time of initial surgical excision, the tumour was found to involve the frontal sinus by expansion from the ethmoids in three of these patients. In the fourth patient, the tumour was found to be massively involving the frontal sinus mucosa. After a mean follow-up of 16.3 months, no recurrences were detected in the first three patients. In the patient with massive mucosal involvement, recurrence was detected 4 years after the initial endonasal endoscopic resection. Subsequently, an osteoplastic flap was performed to resect the tumour. Fifty months later the patient remained disease free. Surgeons managing patients with frontal sinus inverted papilloma should have a clear management scheme before embarking on surgery. The patient’s consent should be obtained pre-operatively for a possible osteoplastic flap. Tumours just expanding into the frontal sinus can be managed by either endoscopic or nonendoscopic approaches. On the other hand, in tumours significantly involving the frontal sinus mucosa, an osteoplastic flap is warranted to ensure complete tumour resection.     

鼻内镜治疗鼻腔鼻窦内翻性乳头状瘤31例临床分析

目的探讨鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤的方法及疗效。方法对31例鼻腔鼻窦内翻性乳头状瘤鼻内镜下先切除鼻腔、筛窦、蝶窦、额窦口、上颌窦口肿瘤及其基部黏骨膜,侵及上颌窦者经柯陆径路内镜下于骨膜下分离切除肿瘤。结果术后随访2.5～7年,平均3.8年。治愈28例(90.32%),复发3例(9.68%)。结论鼻内镜对鼻腔鼻窦内翻性乳头状瘤疗效确切。切除肿瘤及其基部黏骨膜,对侵及上颌窦者联合柯陆径路内镜下治疗,可有效预防术后复发。     

Minimally invasive resection of frontal recess/sinus inverted papilloma

OBJECTIVE: Inverted papilloma (IP) in the frontal recess/sinus poses a unique surgical challenge given the inherent difficulty in endoscopic visualization and limitations in access posed by the anatomic confines of the frontal recess/sinus. The objective of this study is to evaluate the efficacy of the minimally invasive endoscopic approach for resection of frontal recess/sinus IP. STUDY DESIGN: Retrospective chart review. METHODS: Five patients with frontal recess/sinus IP comprised the focus of this study. Patient charts were reviewed for demographic data, tumor location and extent, histopathology, surgical treatment strategy, operative parameters (operative time, blood loss), recurrence rate, and follow-up. RESULTS: The average age was 55 years, and all patients were men. All patients underwent computer-aided endoscopic resection of histologically proven IP as the primary surgical modality. Adjunct approaches including endoscopic frontal trephination and modified endoscopic Lothrop were performed in 1 case each. No intra- or postoperative complications occurred in the patient group. No recurrences were noted by endoscopic and/or radiographic surveillance at mean follow-up of 16.8 months. CONCLUSIONS: The minimally invasive endoscopic approach is effective for successful resection of frontal recess/sinus IP. Adjunctive open approaches or extended frontal drill-out approaches may be required to achieve complete tumor extirpation. Careful preoperative planning coupled with meticulous surgical technique are absolute requisites for successful management of these difficult tumors.     

经鼻内镜下改良Lothrop手术

目的通过报告6例改良经鼻内镜下Lothrop手术经验，探讨相关技术方法的应用及手术适应证的选择。方法6例额窦病变患者，年龄6-63岁；男4例，女2例。4例中额窦骨瘤1例，额窦复发性血管瘤1例，外伤性额窦黏液囊肿2例，术后复发性额窦黏液囊肿1例，额筛窦复发性内翻性乳头状瘤1例。采用经鼻内镜下额窦底切除额窦开放引流手术(modified endoscopic Lothrop procedure，MELP)。其中2例术中在影像导航系统引导下定位和开放额窦底。结果6例均手术成功，术中和术后均未出现并发症，平均手术时间3．2h。随访6～40个月，鼻内镜检查额窦底额窦口融合开放良好，上皮化。患者术前症状消失，无复发。结论在严格适应证、合适器械及良好鼻内镜外科技术和经验的基础上，改良经鼻Lothrop手术是复杂额窦病变治疗方式的理想选择。     

Inverted papilloma: report of 89 cases

PURPOSE: In this study, the surgical management of an inverted papilloma of the nose and paranasal sinuses performed at our institution is reviewed. METHODS: Eighty-nine patients diagnosed with an inverted papilloma and treated at the Ear, Nose, and Throat Department of Bologna University from January 1980 to January 2001 were retrospectively reviewed. Only 86 out of the 89 patients were retrospectively analyzed because 3 patients were treated for malignant tumors because of the association between inverted papilloma and invasive squamous cell carcinoma. Fifty patients were treated using traditional techniques such as lateral rhinotomy and midface degloving with medial maxillectomy (11 cases), a Caldwell-Luc procedure (21 cases), and transnasal ethmoidectomy or sphenoethmoidectomy (18 cases), whereas 36 patients were treated using an endonasal endoscopic approach for their primary tumor. RESULTS: The traditionally treated patients had a mean follow-up of 8 years (6-19 years), whereas the endoscopically treated patients had a mean follow-up of 54 months (24-97 months). The overall recurrence rate was 15%. There were 12 recurrences (24%) in the traditionally treated patients: 1 out of 11 patients (9%) had a recurrence after a medial maxillectomy by means of a lateral rhinotomy/midface degloving, whereas 11 patients out of 39 (28%) had a recurrence after more conservative procedures such as the transantral approach and transnasal ethmoidectomy or sphenoethmoidectomy. On the other hand, 1 recurrence was observed in the endoscopically treated patients (3%). CONCLUSIONS: Traditional techniques such as Caldwell-Luc and conservative transnasal ethmoidectomy or sphenoethmoidectomy are associated with a high rate of recurrence in the treatment of an inverted papilloma. On the other hand, the endoscopic endonasal approach is an effective treatment for an inverted papilloma in selected cases and, when performed by a skilled surgeon, can achieve a radical resection of the tumor because of excellent magnification and visualization, with results comparable to those of traditional techniques such as lateral rhinotomy with medial maxillectomy.     

鼻内镜下切除累及额窦及其引流通道的内翻性乳头状瘤

目的鼻腔鼻窦内翻性乳头状瘤是头颈部常见的良性肿瘤之一，但累及额窦及其引流通道的内翻性乳头状瘤既往报告不多。本研究采用经鼻内镜手术治疗累及额窦及其引流通道的内翻性乳头状瘤，探讨相应术式的适应证及疗效。方法累及额窦及其引流通道的乳头状瘤患者9例（男8例，女1例），年龄23～70岁，中位年龄52岁。所有患者术前均接受CT检查，5例行MRI检查，组织病理学诊断均为内翻性乳头状瘤。根据病变范围进行分期，然后进行经鼻内镜手术治疗并观察疗效。结果根据Krouse分期系统，所有患者病变均为13期，经鼻内镜手术顺利切除肿瘤，其中肿瘤的根基部位于额隐窝外侧壁者4例，采用DrafⅡA型手术；肿瘤根基部位于额隐窝和额漏斗内侧壁和后壁，以及外侧壁和后壁者3例，采用DrafⅡB型手术；he瘤根基部位于额隐窝和额漏斗后壁，或者内侧壁和后壁，且肿瘤累及双侧额窦者2例，采用DrafⅢ型手术。所有患者均在鼻内镜下随访，其中3例术后复查CT，随访5～34个月，中位随访时间16个月。术后组织病理学检查结果均符合术前诊断，未发现局部恶变。结论术前CT和病理检查对明确病变部位和性质至关重要，MRI检查可起到良好的辅助作用。经鼻内镜手术去除累及额窦及其引流通道的T3期乳头状瘤，可取得良好的近期疗效。     

经鼻内镜扩大鼻丘进路额窦手术的探索

目的 探索鼻内镜下改良鼻丘入路治疗额窦病变的手术方法.方法 从2009年1月开始前瞻性收集中山大学附属第一医院住院行鼻内镜下改良鼻丘入路额窦手术的患者资料,包括一般情况、术中所见、术后症状、内镜检查结果及术后并发症情况.结果 从2009年1月到2010年8月共进行了19例改良鼻丘入路额窦手术,其中慢性鼻-鼻窦炎17例,13例(76.5%)痊愈,3例(17.6%)好转,总有效率为94.1%,1例(5.9%)无效;额窦前筛内翻性乳头状瘤2例,治疗后痊愈.随访6～24个月,中位数随访时间16个月.无严重并发症发生,无术后额隐窝粘连,4例额隐窝组织增生、狭窄.结论 鼻内镜下改良鼻丘入路术中对额隐窝和额窦的暴露较好,术野宽敞,术后粘连少,额窦引流通畅,疗效确切.

Abstract：

Objective To explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases. Methods The data of patients undergoing modified agger nasi approach for frontal diseases were prospecitvely collected since January 2009, including demographic data,findings at surgery, presence of postoperative symptoms, endoscopic appearance of the frontal recess and sinus, and complications. Results Nineteen patients were enrolled from January 2009 to August 2010.Seventeen patients had chronic rhinosinusitis, in which 13 patients (76. 5% ) completely healed, 3 patients ( 17. 6% ) improved and 1 patient (5. 9% ) failed Two patients had frontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 months, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy. Conclusion The modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.     

Invertierte Papillome der Nase und ihrer Nebenhöhlen Langzeitergebnisse nach endoskopischer endonasaler Resektion

There is still some skepticism about endoscopic endonasal resection of inverted papillomas. We conducted a long-term retrospective study and examined 104 patients (82 male, 22 female) with inverted papilloma who were operated at the ENT-Department of the University of Erlangen between 1974 and 1997. The endoscopic approach was chosen in each case, either alone or in combination with external approaches. In 64.4% (67 cases), tumors of all T-classes were resected by endoscopic approach alone (T1:17.9%, T2:23.9%, T3:41.8%, T4:16.4%). For the rest of the patients an additional transoral and transfacial approach was necessary due to difficult tumor localization (T2:24.3%, T3:29.7%, T4:45.9%). The mean age of the patients was 55 years. The recurrence rate after primary endoscopic endonasal sinus surgery was 22.4% (15/67) and after combined endoscopic and external surgery 16.2% (6/37). Second salvage surgery after endoscopic sinus surgery was performed again endonasally in 46% (7/15) and externally in 53.3% (8/15). The recurrence rate after the endonasal approach was now 57.1% (4/7) and 50% (4/8) after external surgery. Third salvage surgery was performed again endoscopically in four cases and externally in four cases. The recurrence rate in both groups was 50% each, so that up to six operations, either endoscopically or externally, were necessary for complete tumor resection. The longest period for a tumor recurrence was 3.4 years after endoscopic sinus surgery and 9 years after combined endoscopic and external surgery. A tumor recurrence after endoscopic endonasal sinus surgery that could not be managed endoscopically again occurred in 12%. Tumor localization is the limiting factor for endoscopic endonasal sinus surgery of inverted papilloma. However, in 64.4% of cases, endoscopic endonasal sinus surgery alone was performed successfully without any loss of one patient. Long-term follow-up is necessary since the recurrence of tumor can happen after a long time. Endoscopic endonasal sinus surgery of inverted papilloma is safe and should be preferred due to its minimal invasive character.