The role of endoscopic sinus surgery in the management of sinonasal inverted papilloma

Purpose of reviewInverted papilloma are benign sinonasal tumors that have a propensity to recur after surgical resection and may undergo malignant transformation. For this reason, complete resection is essential for the successful management of these tumors. Advances in endoscopic techniques and experience, as well as improved radiologic accuracy and navigation, are increasing the role of minimally invasive, endoscopic approaches for surgical resection of inverted papilloma. The following represents a review of the important and recent literature on the pathophysiology, diagnosis, and management of inverted papilloma. Recent findingsStudies of altered epithelial cell proliferation and cell cycle regulation have elucidated mechanisms of inverted papilloma pathogenesis. Radiographic findings, such as thickening of bone or osteitis, have been demonstrated to be useful in determining preoperative staging and for surgical planning. Outcomes studies suggest that endoscopic and combined endoscopic/external approaches now equal the effectiveness of traditional open procedures with decreased morbidity and reduced hospital stays. SummaryA better understanding of alterations in epithelial cell proliferation and cell cycle regulation in inverted papilloma may lead to adjuvant medical therapies to decrease recurrence rates and improve treatment. Endoscopic approaches continue to gain acceptance and have become the standard of care for resection of sinonasal inverted papillomas.