Endoscopic dissection of the infraorbital canal in patients with sinonasal inverted papilloma

Intrоduction. Sinonasal papilloma is a benign tumor. The standard treatment for sinonasal inverted papilloma (SIP) is surgical intervention. The tumor is located primarily in the maxillary sinus (50.9 %). Sinonasal inverted papilloma originated from the maxillary sinus has aggressive characteristics and can dislodge local anatomical structures, infraorbital canal in particular.

Aim. To present a descriptive characteristic of structural changes in the infraorbital canal during SIP growth and determine the optimal volume of canal dissection.

Materials and methods. A retrospective study of patients with SIP was performed. From the total cohort (n = 37), 15 patients with primary localization of sinonasal inverted papilloma in the maxillary sinus were selected. In all cases, the same diagnostic algorithm was used. Separately, evaluation of infraorbital canal anatomy based on preoperative analysis of computed tomography of the paranasal sinuses and intraoperative endoscopic exam was performed. Surgical strategy used in all cases consisted of endoscopic SIP tissue removal, total resection of the mucoperiosteum and subperiosteal dissection of all walls of the maxillary sinus using a bur. During surgery material was collected for control histological examination.

Results. In 20 % of cases, changes in the walls of the infraorbital canal in the form of hyperostosis, erosion and dehiscence were observed. In 13.3 % of cases, growth of sinonasal inverted papilloma caused distortions in the structure of infraorbital canal walls. In all cases, computed tomography data showed the same results as intraoperative endoscopic visualization. For removal of the lesion and pathologically changed walls of the infraorbital canal, transnasal endoscopic partial maxillectomies (type 3 or 4) were performed. Follow-up duration varied between 1 and 5 years, mean follow-up duration was 3 years. SIP resection was effective in all patients, no recurrences were observed.

Conclusion. For SIPs growing in the maxillary sinus, condition of the infraorbital canal must be of special interest. The study showed the effectiveness and flexibility of the surgical strategy consisting of the combination of total mucoperiosteum resection with subperiosteal dissection of all walls of the maxillary sinus.

1. Rha M.S., Kim C.H., Yoon J.H., Cho H.J. Association of the human papillomavirus infection with the recurrence of sinonasal inverted papilloma: a systematic review and meta-analysis. Rhinology 2022;60(1):2–10. DOI: 10.4193/Rhin21.255

2. El-Naggar A.K., Chan J.K.C., Grandis J.R. et al. WHO Classification of Tumours: head and neck. 4th edn. Lyon: IARC Press, 2017.

3. Trent M.S., Goshtasbi K., Hui L. et al. A systematic review of definitive treatment for inverted papilloma attachment site and associations with recurrence. Otolaryngol Head Neck Surg 2022;167(3):425–33. DOI: 10.1177/01945998211051975

4. Ferrari M., Schreiber A., Mattavelli D. et al. How aggressive should resection of inverted papilloma be? Refinement of surgical planning based on the 25-year experience of a single tertiary center. Int Forum Allergy Rhinol 2020;10(5):619–28. DOI: 10.1002/alr.22541

5. Busquets J.M., Hwang P.H. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis. Otolaryngol Head Neck Surg 2006;134(3):476–82. DOI: 10.1016/j.otohns.2005.11.038

6. Fang G., Lou H., Yu W. et al. Prediction of the originating site of sinonasal inverted papilloma by preoperative magnetic resonance imaging and computed tomography. Int Forum Allergy Rhinol 2016;6(12):1221–8. DOI: 10.1002/alr.21836

7. Turri-Zanoni M., Battaglia P., Karligkiotis A. et al. Transnasal endoscopic partial maxillectomy: operative nuances and proposal for a comprehensive classification system based on 1378 cases. Head Neck 2017;39(4):754–66. DOI: 10.1002/hed.24676

8. Peng R., Thamboo A., Choby G. et al. Outcomes of sinonasal inverted papilloma resection by surgical approach: an updated systematic review and meta-analysis. Int Forum Allergy Rhinol 2019;9(6):573–81. DOI: 10.1002/alr.22305

9. Wu V., Siu J., Yip J., Lee J.M. Endoscopic management of maxillary sinus inverted papilloma attachment sites to minimize disease recurrence. J Otolaryngol Head Neck Surg 2018;47(1):24. DOI: 10.1186/s40463-018-0271-1

10. Landsberg R., Cavel O., Segev Y. et al. Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma. Am J Rhinol 2008;22(6):629–34. DOI: 10.2500/ajr.2008.22.3243

11. Eide J.G., Welch K.C., Adappa N.D. et al. Sinonasal inverted papilloma and squamous cell carcinoma: contemporary management and patient outcomes. Cancers (Basel) 2022;14(9):2195. DOI: 10.3390/cancers14092195

12. Goudakos J.K., Blioskas S., Nikolaou A. et al. Endoscopic resection of sinonasal inverted papilloma: systematic review and metaanalysis. Am J Rhinol Allergy 2018;32(3):167–74. DOI: 10.1177/1945892418765004

13. Schreiber A., Ferrari M., Rampinelli V. Et al. Modular endoscopic medial maxillectomies: quantitative analysis of surgical exposure in a preclinical setting. World Neurosurg 2017;100:44–55. DOI: 10.1016/j.wneu.2016.12.094

14. Lee J.T., Yoo F., Wang M. et al. Modified endoscopic Denker approach in management of inverted papilloma of the anterior maxillary sinus. Int Forum Allergy Rhinol 2020;10(4):533–8. DOI: 10.1002/alr.22513

15. Stavrakas M., Karkos P.D., Tsinaslanidou Z., Constantinidis J. Endoscopic Denker’s approach for the treatment of extensive sinonasal tumors: our experience. Laryngoscope 2021;131(7): 1458–62. DOI: 10.1002/lary.29235

16. Bertazzoni G., Accorona R., Schreiber A. et al. Postoperative longterm morbidity of extended endoscopic maxillectomy for inverted papilloma. Rhinology 2017;55(4):319–25. DOI: 10.4193/ Rhin17.035

17. Zhou B., Han D.M., Cui S.J. et al. Intranasal endoscopic prelacrimal recess approach to maxillary sinus. Chin Med J (Engl) 2013;126(7):1276–80.

18. Simmen D., Veerasigamani N., Briner H.R. et al. Anterior maxillary wall and lacrimal duct relationship – CT analysis for prelacrimal access to the maxillary sinus. Rhinology 2017;55(2):170–4. DOI: 10.4193/Rhino16.318

19. Arosio A.D., Valentini M., Canevari F.R. et al. Endoscopic endonasal prelacrimal approach: radiological considerations, morbidity, and outcomes. laryngoscope 2021;131(8):1715–21. DOI: 10.1002/lary.29330

20. Vatcharayothin N., Kasemsiri P., Thanaviratananich S., Thongrong C. Evaluating endoscopic ipsilateral endonasal corridor approaches to the anterolateral wall of the maxillary sinus: a computerized tomography study. Int Arch Otorhinolaryngol 2021;26(1):e085–90. DOI: 10.1055/s-0041-1724092

21. Peris-Celda M., Pinheiro-Neto C.D., Scopel T.F. et al. Endoscopic endonasal approach to the infraorbital nerve with nasolacrimal duct preservation. J Neurol Surg B Skull Base 2013;74(6):393–8. DOI: 10.1055/s-0033-1347372

22. Upadhyay S., Dolci R.L., Buohliqah L. et al. Effect of incremental endoscopic maxillectomy on surgical exposure of the pterygopalatine and infratemporal fossae. J Neurol Surg B Skull Base 2016;77(1):66–74. DOI: 10.1055/s-0035-1564057