Endoscopic surgical approach of sinonasal inverted papilloma: A case report and mini review

Sinonasal inverted papilloma (SNIP) is a relatively rare benign tumor that occurs in 0.2-1.5 per 100.000 persons each year, comprising 0.5% - 4% of all sinonasal neoplasms. Despite being benign in nature, SNIP exhibits local aggressiveness due to its distinctive proliferation of metaplastic surface epithelium that undergoes inversion into the underlying stroma. Also, it carries a risk of malignant transformation. These characteristics thus emphasize the necessity for complete surgical excision as the primary treatment.

A 50-year-old woman presented with sinonasal inverted papilloma classified as stage T2 according to Krouse staging, suitable for a less invasive endoscopic approach. However, CT scan revealed maxillary sinusitis. Adhering to SNIP management principles, a surgical excision through Endoscopic Sinus Surgery (ESS) followed by Endoscopic Modified Medial Maxillectomy (EMMM) or prelacrimal approach was chosen to provide better visualization of the anterior, lateral, posterior, inferior, and medial walls of the maxillary sinus. This approach aimed to preserve the inferior turbinate and nasolacrimal, avoiding postoperative lacrimation.