Radiographic and histologic analysis of the bone underlying inverted papillomas

Alexander G Chiu, Alexis H. Jackman, Marcelo B. Antunes, Michael D. Feldman, James N. Palmer

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

INTRODUCTION: Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumor. Those localized to the maxillary sinus or medial maxillary wall have classically been removed through an external approach. In recent years, endoscopic removal has been advocated as an effective, minimally invasive approach. Successful endoscopic management is based on accurate intraoperative identification and complete resection of the tumor. The surgical management of the bone underlying the surface of an IP is less clearcut. Controversy exists as to whether the bony undersurface of an IP should be removed. In this article, histopathologic specimens and preoperative radiologic studies are prospectively examined to better understand the involvement of the bone underlying an inverted papilloma. MATERIALS AND METHODS: A prospective study of patients with maxillary sinus IP treated with endoscopic or endoscopic-assisted resection over a 12-month period was conducted. Intraoperatively, the site of tumor attachment was identified, and a 1- to 2-cm wedge of bone with overlying tumor was removed en bloc and analyzed under light microscopy. Preoperative radiographic studies were analyzed with respect to bony changes in the area of the tumor pedicle. RESULTS: On histopathologic analysis, the bony surface underlying the IP was irregular with multiple bony crevices in all nine cases. In two cases (22% of specimens), an isolated rest of normal-appearingsalivary gland and/or mucosal tissue was seen embedded in the underlying bone. Radiographic osteitic bony changes were seen at site of tumor attachment in 100% of cases. CONCLUSION: The irregularity of the bony surface may hinder complete tumor removal because microscopic rests of mucosa can be hidden within the bony crevices. Intraoperative removal of the bony surface at the site of tumor attachment may ensure a more complete removal.

Original languageEnglish (US)
Pages (from-to)1617-1620
Number of pages4
JournalLaryngoscope
Volume116
Issue number9
DOIs
StatePublished - Sep 2006
Externally publishedYes

Fingerprint

Inverted Papilloma
Bone and Bones
Neoplasms
Maxillary Sinus
Mucous Membrane
Microscopy
Prospective Studies
Light

Keywords

  • Endoscopic surgery
  • Inverted papilloma
  • Neo-osteogenesis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Radiographic and histologic analysis of the bone underlying inverted papillomas. / Chiu, Alexander G; Jackman, Alexis H.; Antunes, Marcelo B.; Feldman, Michael D.; Palmer, James N.

In: Laryngoscope, Vol. 116, No. 9, 09.2006, p. 1617-1620.

Research output: Contribution to journalArticle

Chiu, Alexander G ; Jackman, Alexis H. ; Antunes, Marcelo B. ; Feldman, Michael D. ; Palmer, James N. / Radiographic and histologic analysis of the bone underlying inverted papillomas. In: Laryngoscope. 2006 ; Vol. 116, No. 9. pp. 1617-1620.
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AB - INTRODUCTION: Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumor. Those localized to the maxillary sinus or medial maxillary wall have classically been removed through an external approach. In recent years, endoscopic removal has been advocated as an effective, minimally invasive approach. Successful endoscopic management is based on accurate intraoperative identification and complete resection of the tumor. The surgical management of the bone underlying the surface of an IP is less clearcut. Controversy exists as to whether the bony undersurface of an IP should be removed. In this article, histopathologic specimens and preoperative radiologic studies are prospectively examined to better understand the involvement of the bone underlying an inverted papilloma. MATERIALS AND METHODS: A prospective study of patients with maxillary sinus IP treated with endoscopic or endoscopic-assisted resection over a 12-month period was conducted. Intraoperatively, the site of tumor attachment was identified, and a 1- to 2-cm wedge of bone with overlying tumor was removed en bloc and analyzed under light microscopy. Preoperative radiographic studies were analyzed with respect to bony changes in the area of the tumor pedicle. RESULTS: On histopathologic analysis, the bony surface underlying the IP was irregular with multiple bony crevices in all nine cases. In two cases (22% of specimens), an isolated rest of normal-appearingsalivary gland and/or mucosal tissue was seen embedded in the underlying bone. Radiographic osteitic bony changes were seen at site of tumor attachment in 100% of cases. CONCLUSION: The irregularity of the bony surface may hinder complete tumor removal because microscopic rests of mucosa can be hidden within the bony crevices. Intraoperative removal of the bony surface at the site of tumor attachment may ensure a more complete removal.

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