Endoscopic Management of Sinus Neoplasia: An Experience of a Dedicated Sinus Centre in Image-Guided Surgery of Inverted Papillomata

Previous evidence indicates that the endoscopic approach is the gold standard treatment for sinonasal inverted papillomata (IP). Our objectives were to evaluate the rate of complications and recurrence of IP after management using image-guided endoscopic techniques. This retrospective cohort included patients who underwent tumour resection between 2011 and 2022 in a single sinus-surgery-dedicated centre. In total, 40 patients were treated for IP using endoscopic techniques. The most common site for IP was the maxillary sinus (35%). Cases were managed endoscopically, with 30% having a medial maxillectomy and 15% managed by Draf IIb/III. The rate of complications was 5%, which included 1 case of intra-operative cerebrospinal fluid leak and 1 case with facial numbness. A total of 21 cases had a recurrence—6 (27%) out of the total of 22 primary cases and 15 (83%) out of the total of 18 secondary cases. The difference between the two groups was statistically significant c2(1) = 12.48 and p = 0.0004. The odds ratio was 13.33 (confidence interval, CI 95%: 2.82 to 63.12) with a relative risk of 3.06 (CI 95%: 1.50–6.24). This highlights that the risk and rate of recurrence are higher in secondary cases. As a possible explanation for the results could be that secondary cases were operated by a non-rhinologist ENT (Ears, Nose, and Throat) surgeon. Our results demonstrate that cases operated by a non-rhinologist at first presentation have higher recurrence rates even once a rhinologist was able to manage them. Therefore, IPs managed by a fellowship-trained rhinologist may have superior outcomes in terms of recurrence.