Contemporary Diagnosis and Endoscopic Management Strategy for Inverted Papilloma (2024 AMW)

The advent of endoscopic techniques has refined the management paradigm for paranasal sinus and skull base tumors. Inverted papilloma, the most common benign sinonasal tumor, remains an important entity in the endoscopic era. The locally aggressive nature, high risk of recurrence with incomplete resection, and association with malignancy add to the treatment dilemma. This session will provide practicing otolaryngologists and trainees with up-to-date information on the pertinent pathophysiology, clinical features, diagnostic workup and management schema of inverted papilloma. The relevant pathophysiologic mechanisms, including the role of human papillomavirus and inflammatory pathways in tumor propagation will be discussed. The diagnostic workup, including the role of endoscopy and biopsy will be outlined. The salient radiographic features noted on CT and MR imaging will be reviewed. The paradigm for minimally invasive endoscopic resection utilizing surgical navigation will be discussed. The role of medial maxillectomy, Denker procedure, endoscopic modified Lothrop, extended sphenoid approach, and adjunct open approaches to achieve tumor extirpation will also be elucidated. Surgical nuances of tumor removal by specific subsites for maxillary, ethmoid, sphenoid and frontal sinus IP will be reviewed utilizing case-based scenarios. Management of IP with skull base, lacrimal, or orbital extension and IP with carcinoma will also be discussed. Surgical outcomes, with special attention to recent systematic reviews, will be detailed. Clinical case examples will be utilized throughout the expert series to illustrate management pearls to optimize treatment outcomes.