Endoscopic Sinus Surgery for Inverted Papilloma Involving Frontal Recess and Sinus

Endoscopic nasal and paranasal sinus surgery (ESS) provides superior magnification, illumination, and angled visualization enabling a tumor base to be isolated and the disease extent accurately defined. Extended endoscopic frontal sinus surgery, including Draf type I-III, is effective in treating extensive frontal sinus lesions, but endoscopic endonasal management of inverted papilloma (IP) involving frontal sinus and drainage remains controversial. We analyzed six cases of IP involving the frontal recess and sinus and their clinical outcomes treated from 2005 to 2008. ESS by an experienced surgeon under general anesthesia involved four frontal recess tumors without frontal sinus attachment undergoing Draf type IIa procedures and 2 with frontal recess and infundibulum attachment undergoing Draf type IIb procedures. All were successfully, with an uneventful postoperative course and no recurrence observed in follow-up examination. We concluded that ESS achieves complete IP removal, plus the advantages of no external incision, decreased blood loss, low morbidity, and short hospitalization.