Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. They usually present as unilateral firm, bulky, red and vascular masses. The objective of this case series is to discuss the surgical treatment options for IPs and to review the literature with a special emphasis on our experience with endoscopic medial maxillectomy. A retrospective review of the data of patients with IP treated by endoscopic medial maxillectomy was performed. This report describes the surgical experience with five patients with IP arising from various sites on the lateral nasal wall. Data points collected included age, sex, location(s) and histopathological diagnosis (benign IP vs IP with dysplasia or carcinoma). The surgical treatment strategy, need for adjunct approaches, complications, recurrence rates and length of follow-up were determined. The average age was 51.2 years (range, 35-62 years), with four males and one female. All cases were managed with endoscopic medial maxillectomy as the primary surgical modality. Adjunctive approaches included endoscopic dacryocystorhinostomy (EDCR) in two patients who presented with epiphora post-operatively. Intra-operative frozen section was performed in all cases to ensure complete tumor removal. No intra-operative complications were encountered. No recurrences were noted in these patients, with a mean follow-up period of 23 months.
We describe two cases of nasal inverted papilloma who had different management modalities. Although both were essentially of the same pathology, one underwent endoscopic excision while the other was treated with the more popular lateral rhinotomy and medial maxillectomy. We wish to highlight the different modalities of treatment available for inverted papilloma and a review of published results.
Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.
A retrospective data of 29 patients who underwent various types of maxillectomy from January 1998 till January 2004 in UKM hospital were reviewed. There were 21 males (72%) and 8 females (28%) with mean age of 42 years. Malays were the majority of patients 17 (59%), Chinese 11 (38%) and Indian 1 (3%). Seventeen patients (59%) presented with malignant tumours while 12 patients (41%) with benign tumours. Inverted papilloma (50%) was the commonest benign tumour and squamous cell carcinoma (36%) was the commonest malignancy. Medial maxillectomy was performed in ten patients (35%), total maxillectomy in seven patients (24%), three patients (10%) had near total, three patients (10%) had partial maxillectomy and six patients (21%) underwent inferior maxillectomy.