Sinonasal Inverted Papilloma

What is Sinonasal Inverted Papilloma?

An inverted papilloma of the nose and sinuses is a rare, benign tumor that originates in the nasal cavity and paranasal sinuses. This tumor, also known as Schneiderian papilloma, is a type of benign tumor that arises from the mucous membrane lining of the nasal cavity and paranasal sinuses. It is characterized by its inward growth pattern into the underlying tissues, hence the term "inverted."

Causes of Sinonasal Inverted Papilloma (SNIP)

The exact cause of sinonasal inverted papilloma is not well understood. However, several factors have been associated with its development, including:

• Chronic inflammation of the sinonasal mucosa
• Viral infections, such as human papillomavirus (HPV)
• Occupational exposure to certain chemicals or irritants
• Genetic predisposition

While these factors may increase the risk of developing sinonasal inverted papilloma, the precise mechanism of tumor formation remains unclear.

Pathology of Sinonasal Inverted Papilloma

Histologically, sinonasal inverted papillomas are characterized by a complex growth pattern with invaginations into the underlying stroma. They often exhibit a mixture of epithelial and stromal components, with a propensity for glandular differentiation.

Diagnosis of Sinus Inverted Papilloma

Diagnosing sinonasal inverted papilloma can be challenging due to its nonspecific symptoms and radiographic findings. However, several diagnostic modalities can aid in the identification of this condition.

Clinical Presentation

Patients with sinonasal inverted papilloma may present with the following symptoms:

• Nasal obstruction
• Epistaxis (nosebleeds)
• Chronic sinusitis
• Hyposmia (reduced sense of smell)
• Rhinorrhea (runny nose)

These symptoms are nonspecific and can mimic other sinonasal conditions, necessitating further evaluation for an accurate diagnosis.

Imaging Studies

CT scans of the paranasal sinuses are essential for evaluating the extent and characteristics of sinonasal inverted papilloma. Key findings on CT imaging may include:

• Unilateral sinonasal mass with bony erosion
• Calcifications within the tumor
• Sclerosis of adjacent bone
• Expansion of the sinus walls

MRI may also be useful for delineating soft tissue involvement and assessing the proximity to critical structures, such as the orbit or skull base.

CT Scan Findings of Sinonasal Inverted Papilloma

On CT imaging, sinonasal inverted papillomas typically appear as enhancing soft tissue masses within the sinonasal cavity. Key radiographic features that suggest the presence of inverted papilloma include:

• Focal areas of calcification within the lesion
• Bone remodeling or erosion of adjacent structures
• Hyperostosis or sclerosis of surrounding bone
• Extension into adjacent sinuses or nasal cavity

These imaging findings, in conjunction with clinical symptoms and endoscopic evaluation, aid in establishing the diagnosis.

Surgical Management of Sinonasal Inverted Papilloma

Historically, the treatment of sinus inverted papilloma involved open surgical approaches, such as lateral rhinotomy or midfacial degloving. However, advancements in endoscopic sinus surgery have revolutionized the management of this condition, offering improved outcomes and reduced morbidity.

Endoscopic Resection Techniques

Endoscopic resection of sinus inverted papilloma has become the standard of care due to its minimally invasive nature and excellent visualization of the sinonasal anatomy. Dr. Thomas Higgins specializes in endoscopic modified medial maxillectomy, Dencker's approach underneath or through the nasal lacrimal duct, ethmoidectomy, and skull base surgery for comprehensive tumor removal.

Benefits of Endoscopic Surgery

Endoscopic resection of sinonasal inverted papilloma offers several advantages over traditional open approaches, including:

• Preservation of sinonasal function and aesthetics
• Reduced postoperative pain and recovery time
• Lower risk of complications, such as facial scarring or numbness
• Decreased likelihood of tumor recurrence

Dr. Higgins' expertise in endoscopic techniques ensures optimal tumor removal with minimal disruption to surrounding structures, leading to favorable outcomes for his patients.

Contact Dr. Thomas Higgins for Expert Care of Sinonasal Inverted Papilloma

Sinonasal inverted papilloma is a rare but treatable condition that requires specialized care for optimal outcomes. Dr. Thomas Higgins, MD, MSPH, MBA, offers expertise in endoscopic resections of inverted papilloma, utilizing advanced techniques to ensure thorough tumor removal and preservation of sinonasal function.

If you or a loved one are experiencing symptoms suggestive of a mass in the nose and sinuses or have been diagnosed with this condition, contact Dr. Higgins for a consultation in Louisville, KY or Jeffersonville, IN. With his dedication to patient care and commitment to excellence in rhinology, you can trust in his expertise in the management of sinonasal inverted papilloma. Schedule your appointment today.

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