Sinonasal Papillomas Treatment & Management
- Author: Nader Sadeghi, MD, FRCSC; Chief Editor: Arlen D Meyers, MD, MBA more...
Recognition of the propensity for recurrence and the association with malignancy has led to the evolution of treatment of sinonasal papillomas (SPs). The role of medical therapy is limited; it is used mainly as an adjunct to specific complications such as sinusitis.
Radiation therapy is generally not indicated in the treatment of benign papillomatous lesions. It is ineffective in the treatment of SPs, and it carries the presumed risk of malignant transformation in an otherwise benign lesion. However, radiation therapy can be used in the treatment of advanced and biologically aggressive SPs of the sinonasal tract or in those patients in whom the morbidity of the radical surgery would be intolerable. In cases in which SPs are associated with squamous cell carcinoma, radiation therapy appears to be an effective adjunctive procedure.[11, 12]
Most clinicians agree that surgery is the treatment of choice for SPs. However, no consensus has been reached on the type or extent of surgical intervention.
The 3 goals of an adequate surgical procedure are to (1) allow exposure sufficient for complete resection of the tumor, (2) provide an unobstructed view for postoperative surveillance of the cavity, and (3) minimize cosmetic deformities and functional disabilities.
Early attempts to treat inverting papillomas with simple and conservative procedures frequently resulted in recurrence rates of 40-80%. Included among the conservative procedures were the intranasal approach (alone or combined with the Caldwell-Luc operation) and Denker rhinotomy. This high recurrence rate combined with the possibility of the multicentric origin of SPs led many surgeons to advocate aggressive early management with medial maxillectomy by using either lateral rhinotomy or midfacial degloving. A review of the surgical anatomy in the areas of recurrences show that the most common sites of recurrence are the lateral nasal wall in the middle meatus, the nasofrontal duct area, the supraorbital ethmoid cells, the region of the lacrimal fossa, and the infraorbital or prelacrimal recess of the maxillary sinus.
Many surgeons consider lateral rhinotomy with en bloc ethmoidectomy and medial maxillectomy the treatment of choice for SPs. This surgical procedure is associated with a recurrence rate lower than that of other conservative procedures. Michaux first described the lateral-rhinotomy approach in 1848, and popularized it in Moure in 1902. Wong and Heeneman refined the approach with 4 subtypes.
In the last 10 years, increasing numbers of authors have reported on endoscopic resection of SP. When appropriately performed, these procedures have success and recurrence rates similar to those of open medial maxillectomy. In many institutions, endoscopic or endoscopy-assisted resection, including transnasal endoscopic medial maxillectomy (TEMM), tailored to the extent of disease is becoming a common treatment. The authors recently reported on the anatomic basis for TEMM as an oncologic approach for sinonasal neoplasms. A recent meta-analysis and another systematic literature review support endoscopic approach as a favorable treatment option compared with open approaches.[15, 16, 17, 18]
Lateral rhinotomy approach
The lateral rhinotomy approach involves a curvilinear incision between the medial canthus and the dorsum of the nose. For this procedure, start the incision under the medial end of the eyebrow, extend the incision inferiorly between the medial canthus and the nasal dorsum and along the deep nasal-cheek groove adjacent to the ala of nose. Then, swing the incision up onto the floor of the nose. The incision includes the full thickness of skin down to the periosteum. A gentle W- or Z-plasty incision can be incorporated into the medial canthus region to help prevent postoperative webbing of the soft tissue.
After the skin incision is made, elevate the periosteum to expose the medial orbital wall, the anterior maxillary wall up to the infraorbital foramen, and the pyriform aperture. The nasal bones can be retracted medially after medial and lateral osteotomies are performed. To achieve en bloc resection, perform osteotomies through the inferior and anterior aspects of the medial wall of the maxilla, through the medial wall of the orbit just inferior to the frontoethmoid suture line, and through the inferior orbital rim and orbital floor. By connecting these osteotomies, the specimen can be mobilized by using a heavy, curved Mayo scissors, which can be used separate the specimen from the posterior wall of the maxillary sinus.
For medial maxillectomy, include the region of the lacrimal fossa, the infraorbital rim, and the prelacrimal recess of the maxillary sinus. Divide the lateral nasal wall along the floor of the nose. Amputate the middle turbinate below its superior attachment, and remove the entire lateral wall intact after its detachment from the rest of the infraorbital rim.
To avoid epiphora, which is a common postoperative complication of this procedure, always incorporate dacryocystorhinostomy. Dacryocystorhinostomy can be accomplished by catheterization of the lacrimal duct by using an indwelling silicone tube (Guibor tube) or by incising the lacrimal sac vertically and sewing the edges to the adjacent tissues.
The medial canthus is usually displaced from its insertion and should be fixed to prevent unsightly telecanthus. If the tendon elevated is attached to the periosteum, it resumes its normal position after careful closure of the periosteum. Sometimes, the tendon is transected and should be tagged and approximated at the end of the procedure. Transnasal wiring is required if the lacrimal crest and adjacent bone are included in the resection.
Midfacial degloving approach
An alternative, versatile, and recommended approach is midfacial degloving for total excision of the SP. This approach consists of lifting the soft tissue from the mid portion of the face by means of a sublabial incision.
Four types of incisions are required in the midfacial degloving approach: (1) bilateral intercartilaginous incisions, (2) a complete septocolumellar transfixion incision, (3) bilateral sublabial incisions from the maxillary tuberosity to the tuberosity, and (4) bilateral pyriform aperture incisions extending to the vestibule. These incisions facilitate exposure of the pyriform aperture and the lateral nasal wall. En bloc resection of the lateral nasal wall is easy to perform, and it affords the possibility of extending the procedure to include the sphenoethmoidectomy and the medial orbital wall as dictated by the extent of the lesion.
Advantages of this approach include no external scarring, good visibility of the operative field, and simultaneous bilateral exposure. In addition, the recurrence rate of SP excised by using the midfacial degloving procedure is similar to those of lateral rhinotomy and medial maxillectomy. As with the lateral rhinotomy, the midfacial degloving approach can be combined with the craniofacial approach to treat lesions involving the base of the skull or anterior cranial fossa.
The primary limitation of the midfacial degloving approach is when surgery is required for more extensive tumors that invade the supraorbital ethmoid cells or the frontal sinus, which require a separate incision. Septal translocation through a sublabial incision is another approach that shares the same advantages of the midfacial degloving approach. It provides wide exposure with no external scarring.
Endoscopic medial maxillectomy
Stammberger reported the first purely endoscopic approach for treatment of SP, which was performed in 15 patients in 1981. Since then, numerous authors have reported their experience with endoscopic or endoscopy-assisted endonasal approaches. More than 500 reported cases have been treated with this technique. Most reported endoscopic resections have involved piecemeal resection of the inverting papilloma followed by piecemeal resection of the lateral nasal wall. Recent literature supports the concept of piecemeal resection or debulking of the intranasal component to then allow complete subperiosteal excision of all diseased mucosa around the origin. Different endoscopic surgical strategies can be used with reported success tailored to the extent of disease.
In tumors limited to the middle meatus, the anterior and posterior ethmoids, or the sphenoethmoidal recess, limited resection (less than endoscopic medial maxillectomy) may be performed. This resection includes anterior ethmoidectomy with clearance of frontal recess, posterior ethmoidectomy, large middle antrostomy, sphenoidotomy, and partial or complete middle turbinectomy. This procedure can be done en bloc.
Tumors that extend from the middle meatus into the maxillary sinus or that originate from the medial wall of the maxillary sinus should be treated with TEMM that includes resection of nasolacrimal duct to allow for complete removal of the medial maxilla. A recent anatomic study revealed that 65% of the volume of maxillary sinus falls bellow the attachment of inferior turbinate to the lateral nasal wall, and the nasolacrimal canal limits the visualization and access to lateral and anterior maxillary sinus wall. This forms the basis for TEMM when the maxillary sinus is involved by the tumor.
Tumors that originate from or that involve the posterolateral, anterior, or inferior wall of the maxillary sinus may be managed with extended endoscopic medial maxillectomy to include these areas. Some authors have suggested the addition of a Caldwell-Luc procedure to the endoscopic approach in these circumstances.
The author's technique for TEMM involves en bloc resection of the entire lateral nasal wall and the tumor under endoscopic visualization as seen in the image below.
After general endotracheal anesthesia is administered, perform topical intranasal decongestion with 2% oxymetazoline-soaked neurosurgical pledgets. Transorally infiltrate 1% lidocaine with 1:100,000 epinephrine into the sphenopalatine foramen. Inject the medication intranasally along the inferior meatal wall, into the turbinates, along the maxillary crest, up to the attachment of the middle turbinate, and into the tumor. Make the initial incision along the superior resection margin, which includes the ethmoids as seen in the image below. Apply bipolar cautery, then sever the attachment of the middle turbinate to the lateral nasal wall with endoscopic scissors.
By using a Freer elevator, perform the dissection along the roof of the ethmoids up to the sphenoid rostrum. Identify the ethmoid arteries, and cauterize them with bipolar cautery. Next, perform inferior resection, as seen in the image below, at the inferior meatus. Cut the mucosa with the electrocautery device at the junction of the lateral wall and the floor of the nose. Perform inferior meatotomy at the anterior end of the meatus. By using a straight osteotome, osteotomize the inferior meatus up to the posterior wall of the maxillary sinus.
Anterior resection, as seen in the image below, includes a cut made inferiorly from the anterior attachment of the middle turbinate to include the uncinate process and the maxillary crest. The cut is continued anterior to the inferior turbinate head to connect to the inferior meatotomy cuts.
After the soft tissue is elevated, perform anterior osteotomy along the maxillary crest into the maxillary sinus. Then, sever the nasolacrimal duct with endoscopic scissors and include the duct in the specimen. Mobilize the lateral wall medially with progressive dissection until it is pedicled on the sphenopalatine artery (as seen in the image below). Likewise, mobilize any tumor in the sinus.
Clip, cauterize, and cut the sphenopalatine artery. Cut the posterior attachment of the inferior turbinate, and remove the lateral wall along with the tumor. Remove the remaining mucosa of the ethmoids superiorly, and laterally if needed, for margin control, and remove the lining of the maxillary sinus if needed for margin control. If necessary, the lamina papyracea and adjacent medial wall of the orbit may be removed. By using 30° and 70° scopes, the entire lining of the superior and lateral wall of the maxillary sinus can be visualized, and the mucosa can be removed to clear potential multicentric disease. The anterior wall of the sphenoid sinus can easily be resected if needed.
Important in the management of sinonasal SPs is long-term follow-up. Many authors believe that most recurrences occur within the first 2 years of treatment. However, most recurrences are observed 5-10 years after treatment. Start follow-up care at regular intervals for at least 5 years after initial management. Nasal endoscopy is essential for follow-up and monitoring for disease recurrence.
Complications can occur after surgical resection of sinonasal papillomas (SPs). The most serious complications are related to the orbit. Blepharitis, diplopia, and intermittent dacryocystitis have been reported after lateral rhinotomy and medial maxillectomy. Ectropion can result secondary to scarring with a downward pull of the lower lid. CSF leak can develop if the base of the skull is violated during surgery.
Late complications include prolonged crusting, infection, nasocutaneous fistula, vestibular stenosis, and nasal-valve collapse.
The most common complication after the midfacial degloving procedure is vestibular stenosis. Oroantral fistula, intermittent paresthesia, and prolonged crusting can also occur.
Endoscopic resection poses the same risk of any endoscopic sinus surgery. Potential complications include CSF leak, orbital complications (orbital or periorbital hematoma, diplopia, injury to the optic nerve, injury to the extraocular muscle, epiphora) prolonged crusting, bleeding, infection, and synechia.
Future and Controversies
The advent of nasal endoscopy, with strong illumination, superior resolution, and angled visualization, together with advances in CT scanning and MRI, have led to precise identification, good localization, and successful resection of intranasal lesions (including SPs) by using an endoscopic approach.
Many reports in the literature support successful treatment of SPs with endoscopic sinus surgery. Preoperative CT scanning and MRI allow for an accurate assessment of the extent of the lesion and, hence, allow for improved selection of the lesions appropriate for endoscopic resection. MRI can help in clearly distinguishing a tumor from opacification secondary to obstructive sinusitis. Endoscopic resection may include total sphenoethmoidectomy, wide meatotomy, resection of the middle turbinectomy, and visualization of the frontal sinus. Some have advocated sampling of the margins. All specimens should be sent for histopathologic examination to ensure complete removal of papillomatous lesions.
Authors of a new study advocate the use of a microdebrider with endoscopic sinus surgery to resect SPs. The various tissues resected and suctioned through the microdebrider must be collected in a separate container and sent for histopathologic study to rule out malignancy. The different tissue entities resected by using the microdebrider do not lose their important morphologic features.
Investigators continue to endorse the endoscopic approach as a feasible and effective approach for the treatment of sinonasal papilloma. The technique is increasing refined and tailored to the extent of the disease, and systematic and well-defined steps to reproducibly perform endoscopic medial maxillectomy are defined. Authors with long-term experience with the open approaches are also performing endoscopic approaches with comparable or improved success.
The advantages of the endoscopic transnasal approach over traditional medial maxillectomy are the lack of an external scar and its related potential for cosmetic deformity; shortened hospitalization; decreased blood loss; and ability to directly visualize the precise extent of the tumor, which increases the likelihood of complete resection. Furthermore, the reported recurrence rate of SPs after endoscopic resection (approximately 17%) is comparable with that of the standard technique of lateral rhinotomy and medial maxillectomy.
The endoscopic approach had already been successful in papillomatous lesions confined to the lateral nasal wall or minimally extending into adjacent paranasal sinuses. Reports also suggest its effectiveness in more advanced disease. Involvement of the maxillary sinus is no longer considered a contraindication to endoscopic or endoscopy-assisted surgery. Some authors have suggested the addition of the Caldwell-Luc procedure to the endoscopic approach when the anterior or posterolateral maxillary sinus is involved. The presence of carcinoma in the endoscopically resected specimen likely indicates a need for more aggressive treatment, depending on the size and location of the carcinomatous foci. For tumors that arise from the frontal sinus, endoscopic sinus surgery is similarly contraindicated.
Detailed preoperative assessment of the extent of the lesion with CT and/or MRI helps in selecting and individualizing the approach for each patient. In addition, the skill and experience of the surgeon with regard to a particular procedure are important factors in selecting the right approach for each patient.
For additional information, see Human Papillomavirus.
Ward N. A mirror of the practice of medicine and surgery in the hospitals of London. London Hosp Lancet. 1854. 2:480-2.
Kramer R, Som ML. True papilloma of the nasal cavity. Arch Otolaryngol. 1935. 22-43.
Ringertz N. Pathology of malignant tumors arising in the nasal and paranasal cavities and maxilla. Acta Otolaryngol (Stockh). 1938. 27 (Suppl):31-42.
d'Errico A, Zajacova J, Cacciatore A, Baratti A, Zanelli R, Alfonzo S, et al. Occupational risk factors for sinonasal inverted papilloma: a case-control study. Occup Environ Med. 2013 Jun 5. [Medline].
Respler DS, Jahn A, Pater A, Pater MM. Isolation and characterization of papillomavirus DNA from nasal inverting (schneiderian) papillomas. Ann Otol Rhinol Laryngol. 1987 Mar-Apr. 96(2 Pt 1):170-3. [Medline].
Weber RS, Shillitoe EJ, Robbins KT, Luna MA, Batsakis JG, Donovan DT, et al. Prevalence of human papillomavirus in inverted nasal papillomas. Arch Otolaryngol Head Neck Surg. 1988 Jan. 114(1):23-6. [Medline].
Stoddard DG Jr, Keeney MG, Gao G, et al. Transcriptional Activity of HPV in Inverted Papilloma Demonstrated by In Situ Hybridization for E6/E7 mRNA. Otolaryngol Head Neck Surg. 2015 Apr. 152(4):752-8. [Medline].
Phillips PP, Gustafson RO, Facer GW. The clinical behavior of inverting papilloma of the nose and paranasal sinuses: report of 112 cases and review of the literature. Laryngoscope. 1990 May. 100(5):463-9. [Medline].
Kim K, Kim D, Koo Y, Kim CH, Choi EC, Lee JG, et al. Sinonasal carcinoma associated with inverted papilloma: a report of 16 cases. J Craniomaxillofac Surg. 2011 Aug 18. [Medline].
Nudell J, Chiosea S, Thompson LD. Carcinoma ex-Schneiderian papilloma (malignant transformation): a clinicopathologic and immunophenotypic study of 20 cases combined with a comprehensive review of the literature. Head Neck Pathol. 2014. 8(3):269-86. [Medline]. [Full Text].
Strojan P, Ferlito A, Lund VJ, Kennedy DW, Silver CE, Rinaldo A, et al. Sinonasal inverted papilloma associated with malignancy: The role of human papillomavirus infection and its implications for radiotherapy. Oral Oncol. 2011 Nov 16. [Medline].
Wong J, Heeneman H. Lateral rhinotomy for intranasal tumors: a review of 22 cases. J Otolaryngol. 1986 Jun. 15(3):151-4. [Medline].
Tanna N, Edwards JD, Aghdam H, Sadeghi N. Transnasal endoscopic medial maxillectomy as the initial oncologic approach to sinonasal neoplasms: the anatomic basis. Arch Otolaryngol Head Neck Surg. 2007 Nov. 133(11):1139-42. [Medline].
Busquets JM, Hwang PH. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis. Otolaryngol Head Neck Surg. 2006 Mar. 134(3):476-82. [Medline].
Karkos PD, Fyrmpas G, Carrie SC, Swift AC. Endoscopic versus open surgical interventions for inverted nasal papilloma: a systematic review. Clin Otolaryngol. 2006 Dec. 31(6):499-503. [Medline].
Dragonetti A, Gera R, Sciuto A, Scotti A, Bigoni A, Barbaro E, et al. Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification. Rhinology. 2011 Jun. 49(2):207-13. [Medline].
Habib AR, Hathorn I, Sunkaraneni VS, Srubiski A, Javer AR. Blood transfusion requirements for endoscopic sinonasal inverted papilloma resections. J Otolaryngol Head Neck Surg. 2012 Dec 1. 41(6):413-8. [Medline].
Barnes EL, ed. Surgical Pathology of the Head and Neck. New York, NY: Marcel Dekker; 1985. Vol 1: 411.
Batsakis JG. Squamous cell "papillomas" of the oral cavity, sinonasal tract and larynx. Batsakis JG, ed. Tumors of the Head and Neck. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 1979. 130-43.
Benninger MS, Lavertu P, Levine H, Tucker HM. Conservation surgery for inverted papillomas. Head Neck. 1991 Sep-Oct. 13(5):442-5. [Medline].
Bernard PJ, Biller HF, Lawson W, LeBenger J. Complications following rhinotomy. Review of 148 patients. Ann Otol Rhinol Laryngol. 1989 Sep. 98(9):684-92. [Medline].
Bielamowicz S, Calcaterra TC, Watson D. Inverting papilloma of the head and neck: the UCLA update. Otolaryngol Head Neck Surg. 1993 Jul. 109(1):71-6. [Medline].
Calcaterra TC, Thompson JW, Paglia DE. Inverting papillomas of the nose and paranasal sinuses. Laryngoscope. 1980 Jan. 90(1):53-60. [Medline].
Chee LW, Sethi DS. The endoscopic management of sinonasal inverted papillomas. Clin Otolaryngol Allied Sci. 1999 Feb. 24(1):61-6. [Medline].
Dolgin SR, Zaveri VD, Casiano RR, Maniglia AJ. Different options for treatment of inverting papilloma of the nose and paranasal sinuses: a report of 41 cases. Laryngoscope. 1992 Mar. 102(3):231-6. [Medline].
Eavey RD. Inverted papilloma of the nose and paranasal sinuses in childhood and adolescence. Laryngoscope. 1985 Jan. 95(1):17-23. [Medline].
Fechner RE, Sessions RB. Inverted papilloma of the lacrimal sac, the paranasal sinuses and the cervical region. Cancer. 1977 Nov. 40(5):2303-8. [Medline].
Hyams VJ. Papillomas of the nasal cavity and paranasal sinuses. A clinicopathological study of 315 cases. Ann Otol Rhinol Laryngol. 1971 Apr. 80(2):192-206. [Medline].
Hyams VJ, Batsakis JG, Michaels L. Papilloma of the upper respiratory tract. Hyams VJ, Batsakis JG, Michaels L, eds. Tumors of the Upper Respiratory Tract and Ear, Atlas of Tumor Pathology. Washington, DC: Armed Forces Institute Press; 1988. 34-51.
Judd R, Zaki SR, Coffield LM, Evatt BL. Sinonasal papillomas and human papillomavirus: human papillomavirus 11 detected in fungiform Schneiderian papillomas by in situ hybridization and the polymerase chain reaction. Hum Pathol. 1991 Jun. 22(6):550-6. [Medline].
Kamel RH. Transnasal endoscopic medial maxillectomy in inverted papilloma. Laryngoscope. 1995 Aug. 105(8 Pt 1):847-53. [Medline].
Lawson W, Biller HF, Jacobson A, Som P. The role of conservative surgery in the management of inverted papilloma. Laryngoscope. 1983 Feb. 93(2):148-55. [Medline].
Lawson W, Kaufman MR, Biller HF. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope. 2003 Sep. 113(9):1548-56. [Medline].
Lawson W, Le Benger J, Som P, Bernard PJ, Biller HF. Inverted papilloma: an analysis of 87 cases. Laryngoscope. 1989 Nov. 99(11):1117-24. [Medline].
Lee TJ, Huang SF, Lee LA, Huang CC. Endoscopic surgery for recurrent inverted papilloma. Laryngoscope. 2004 Jan. 114(1):106-12. [Medline].
Majumdar B, Beck S. Inverted papilloma of the nose. Some aspects of aetiology. J Laryngol Otol. 1984 May. 98(5):467-70. [Medline].
Maniglia AJ. Indications and techniques of midfacial degloving. A 15-year experience. Arch Otolaryngol Head Neck Surg. 1986 Jul. 112(7):750-2. [Medline].
Maniglia AJ, Phillips DA. Midfacial degloving for the management of nasal, sinus, and skull-base neoplasms. Otolaryngol Clin North Am. 1995 Dec. 28(6):1127-43. [Medline].
McCary WS, Gross CW, Reibel JF, Cantrell RW. Preliminary report: endoscopic versus external surgery in the management of inverting papilloma. Laryngoscope. 1994 Apr. 104(4):415-9. [Medline].
Mickelson SA, Nichols RD. Denker rhinotomy for inverted papilloma of the nose and paranasal sinuses. Henry Ford Hosp Med J. 1990. 38(1):21-4. [Medline].
Moore KL, Persaud TVN. The branchial or pharyngeal apparatus. The Developing Human: Clinically Oriented Embryology. 5th ed. Philadelphia, PA: WB Saunders; 1993. 186-225.
Myers EN, Fernau JL, Johnson JT, Tabet JC, Barnes EL. Management of inverted papilloma. Laryngoscope. 1990 May. 100(5):481-90. [Medline].
Myers EN, Schramm VL Jr, Barnes EL Jr. Management of inverted papilloma of the nose and paranasal sinuses. Laryngoscope. 1981 Dec. 91(12):2071-84. [Medline].
Norris HJ. Papillary lesions of the nasal cavity and paranasal sinuses. II. Inverting papillomas. A study of 29 cases. Laryngoscope. 1963 Jan. 73:1-17. [Medline].
O'Reilly BJ, Zuk R. Transitional type papilloma of the nasopharynx. J Laryngol Otol. 1989 May. 103(5):528-30. [Medline].
Pelausa EO, Fortier MA. Schneiderian papilloma of the nose and paranasal sinuses: the University of Ottawa experience. J Otolaryngol. 1992 Feb. 21(1):9-15. [Medline].
Price JC, Holliday MJ, Johns ME, Kennedy DW, Richtsmeier WJ, Mattox DE. The versatile midface degloving approach. Laryngoscope. 1988 Mar. 98(3):291-5. [Medline].
Rice DH. Endonasal surgery for nasal wall tumors. Otolaryngol Clin North Am. 1995 Dec. 28(6):1117-25. [Medline].
Ridolfi RL, Lieberman PH, Erlandson RA, Moore OS. Schneiderian papillomas: a clinicopathologic study of 30 cases. Am J Surg Pathol. 1977 Mar. 1(1):43-53. [Medline].
Roberts WH, Dinges DL, Hanly MG. Inverted papilloma of the middle ear. Ann Otol Rhinol Laryngol. 1993 Nov. 102(11):890-2. [Medline].
Sachs ME, Conley J, Rabuzzi DD, Blaugrund S, Price J. Degloving approach for total excision of inverted papilloma. Laryngoscope. 1984 Dec. 94(12 Pt 1):1595-8. [Medline].
Sadeghi N, Al-Dhahri S, Manoukian JJ. Transnasal endoscopic medial maxillectomy for inverting papilloma. Laryngoscope. 2003 Apr. 113(4):749-53. [Medline].
Scheffner M, Werness BA, Huibregtse JM, Levine AJ, Howley PM. The E6 oncoprotein encoded by human papillomavirus types 16 and 18 promotes the degradation of p53. Cell. 1990 Dec 21. 63(6):1129-36. [Medline].
Schlosser RJ, Mason JC, Gross CW. Aggressive endoscopic resection of inverted papilloma: an update. Otolaryngol Head Neck Surg. 2001 Jul. 125(1):49-53. [Medline].
Segal K, Atar E, Mor C, Har-El G, Sidi J. Inverting papilloma of the nose and paranasal sinuses. Laryngoscope. 1986 Apr. 96(4):394-8. [Medline].
Sellars SL, Rosen G. The inverted nasal papilloma. J Laryngol Otol. 1982 Dec. 96(12):1109-12. [Medline].
Smith O, Gullane PJ. Inverting papilloma of the nose: analysis of 48 patients. J Otolaryngol. 1987 Jun. 16(3):154-6. [Medline].
Snyder RN, Perzin KH. Papillomatosis of nasal cavity and paranasal sinuses (inverted papilloma, squamous papilloma). A clinicopathologic study. Cancer. 1972 Sep. 30(3):668-90. [Medline].
Sofferman RA. The septal translocation procedure: an alternative to lateral rhinotomy. Otolaryngol Head Neck Surg. 1988 Jan. 98(1):18-25. [Medline].
Stankiewicz JA, Girgis SJ. Endoscopic surgical treatment of nasal and paranasal sinus inverted papilloma [published erratum appears in Otolaryngol Head Neck Surg 1994 Apr;110(4):476]. Otolaryngol Head Neck Surg. 1993 Dec. 109(6):988-95. [Medline].
Strauss M, Jenson AB. Human papillomavirus in various lesions of the head and neck. Otolaryngol Head Neck Surg. 1985 Jun. 93(3):342-6. [Medline].
Suh KW, Facer GW, Devine KD, Weiland LH, Zujko RD. Inverting papilloma of the nose and paranasal sinuses. Laryngoscope. 1977 Jan. 87(1):35-46. [Medline].
Tomenzoli D, Castelnuovo P, Pagella F, Berlucchi M, Pianta L, Delu G, et al. Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients. Laryngoscope. 2004 Feb. 114(2):193-200. [Medline].
Vrabec DP. The inverted Schneiderian papilloma: a 25-year study. Laryngoscope. 1994 May. 104(5 Pt 1):582-605. [Medline].
Vrabec DP. The inverted Schneiderian papilloma: a clinical and pathological study. Laryngoscope. 1975 Jan. 85(1):186-220. [Medline].
Waitz G, Wigand ME. Results of endoscopic sinus surgery for the treatment of inverted papillomas. Laryngoscope. 1992 Aug. 102(8):917-22. [Medline].
Weiner JS, Sherris D, Kasperbauer J, Lewis J, Li H, Persing D. Relationship of human papillomavirus to Schneiderian papillomas. Laryngoscope. 1999 Jan. 109(1):21-6. [Medline].
Weisman R. Lateral rhinotomy and medial maxillectomy. Otolaryngol Clin North Am. 1995 Dec. 28(6):1145-56. [Medline].
Wenig B. Neoplasm of the nasal cavity and paranasal sinuses. Atlas of Head and Neck Pathology. Philadelphia, Pa: WB Saunders; 1993. 29-95.
Wenig BM. Schneiderian-type mucosal papillomas of the middle ear and mastoid. Ann Otol Rhinol Laryngol. 1996 Mar. 105(3):226-33. [Medline].
Wormald PJ, Ooi E, van Hasselt CA, Nair S. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Laryngoscope. 2003 May. 113(5):867-73. [Medline].
Yousem DM, Fellows DW, Kennedy DW, Bolger WE, Kashima H, Zinreich SJ. Inverted papilloma: evaluation with MR imaging. Radiology. 1992 Nov. 185(2):501-5. [Medline].
Zweig JL, Schaitkin BM, Fan CY, Barnes EL. Histopathology of tissue samples removed using the microdebrider technique: implications for endoscopic sinus surgery. Am J Rhinol. 2000 Jan-Feb. 14(1):27-32. [Medline].