Inverted Papilloma Resection: Endoscopic Medial Maxillectomy in HD

Indications:

• Inverted Papilloma (Schneiderian Papilloma)
• Benign sinonasal neoplasms arising from the lateral nasal wall or maxillary sinus

Highlights:

• Sinonasal landmarks are identified, including the maxillary sinus ostium, middle & inferior turbinates, and ethmoid roof
• Attachment of the tumor (stalk) is identified and transected
• Bulk of the tumor is excised
• Bone at the base of the tumor (stalk attachment site) is drilled and/or resected in order to clear microscopic disease
• The entire lateral nasal wall, including the inferior turbinate, is resected
• At the completion of surgery the maxillary sinus and nose should be a common cavity, enhancing postoperative surveillance for tumor recurrence

Keep in mind:

• If the nasolacrimal duct is transected during surgery, a lacrimal stent is placed to decrease the likelihood of postoperative epiphora. This stent is removed one week after surgery.
• Postoperative nasal saline irrigations are helpful to clear crusts which commonly form after this surgery