Sinonasal papilloma Dr Kalpesh Patel Introduction Sinonasal papilloma

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Sinonasal papilloma - Dr. Kalpesh Patel

Sinonasal papilloma - Dr. Kalpesh Patel

Introduction • Sinonasal papilloma are of three types. Inverted type, cylindrical cell type and

Introduction • Sinonasal papilloma are of three types. Inverted type, cylindrical cell type and exophytic type. • A true papilloma of the mucosa of the nose and paranasal sinuses, the inverted papilloma is the commonest of three types of sinonasal papilloma. • Inverted papilloma represents a benign neoplastic proliferation with a high recurrence rate. It has the propensity for invasion into adjacent structures, such as the orbit and CNS even in the absence of malignancy. • Inverted papillomas account for approximately 0. 5 - 4. 0% of all nasal tumours and are most frequently seen in patients 40 - 60 years of age. • small risk of malignancy, which may coexist at the time of presentation or develop at a later time.

causes • Allergic rhinitis. • Extrinsic factors : air pollution, industrial carcinogens. • Viruses:

causes • Allergic rhinitis. • Extrinsic factors : air pollution, industrial carcinogens. • Viruses: Human Papilloma virus.

Case Presentation • A 36 yrs old patient came to dhiraj general hospital with

Case Presentation • A 36 yrs old patient came to dhiraj general hospital with chief complaints of: • Unilateral nasal obstruction. Other symptoms epistaxis, nasal discharge, epiphora, and facial pain. • Physical examination revealed a unilateral polypoidal mass filling the nasal cavity and causing nasal obstruction which had an irregular, friable appearance, and bleed when touched. • reddish gray and may completely fill the nasal cavity, extending from the vestibule to the nasopharynx. • The nasal septum is bowed to the contralateral side.

 • Plain film • No longer has a significant role play in the

• Plain film • No longer has a significant role play in the assessment of sinonasal disease. If obtained the most common finding is that of a nasal mass with associated opacification of the adjacent maxillary antrum 1.

Radiological features • CT scan findings: • Ct scans plays a vital role in

Radiological features • CT scan findings: • Ct scans plays a vital role in diagnosing and differentiating from other paranasal sinus pathology.

DISCUSSION • Inverted papillomas most commonly occur on the lateral wall of the nasal

DISCUSSION • Inverted papillomas most commonly occur on the lateral wall of the nasal cavity, most frequently related to middle turbinate and maxillary ostium, although they are seen elsewhere in the nasal passage. As the mass enlarges it results in bony remodelling and resorption and often extends into the maxillary antrum. • Due to the location, impairment of normal drainage of the maxillary antrum is common, although mucocoele formation is rare.

Grading of Inverted Papilloma • • • . Grade I Lesions involving nasal cavity

Grading of Inverted Papilloma • • • . Grade I Lesions involving nasal cavity only. Grade II Lesions involving nasal cavity + Paranasal sinuses. Grade III Lesions involving nasal cavity + Paranasal sinuses +Intracranial extension

Differential diagnosis • sinonasal carcinoma : unfortunately imaging is unable to confidently distinguish between

Differential diagnosis • sinonasal carcinoma : unfortunately imaging is unable to confidently distinguish between inverted papillomas, inverted papilloma with malignancy and pure malignancy • antrochoanal polyp : only peripheral enhancement (if any) • inflammatory polyp : only peripheral enhancement (if any) • juvenile nasopharyngeal angiofibroma (JNA) • olfactory neuroblastoma • paranasal sinus mucocoele

Treatment • The search for an ideal surgical approach to removing inverted papillomas has

Treatment • The search for an ideal surgical approach to removing inverted papillomas has been fairly controversial, with proponents of radical surgery vying with those who support endoscopic endonasal procedures. The external approaches include medial maxillectomy, frontoethmoidectomy, mid facial degloving and Caldwell-Luc surgeries. • Advantages and Disadvantages of endoscopic surgery. It is a less invasive procedure and you have a multiangle visualization and absence of facial scarring. In terms of disadvantages - orbit injury, CSF leak, and periorbital ecchymosis • Endoscopic sinus surgery is contraindicated for tumors that arise from the lateral wall of the maxillary sinus and frontal sinus.

THANK YOU

THANK YOU