A Systematic Review of Definitive Treatment for Inverted Papilloma Attachment Site and Associations With Recurrence

Otolaryngol Head Neck Surg. 2022 Sep;167(3):425-433. doi: 10.1177/01945998211051975. Epub 2021 Oct 12.


Objective: Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence.

Data sources: PubMed and Ovid Medline.

Review methods: A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed.

Results: Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P = .045).

Conclusion: Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall.

Level of evidence: 3.

Keywords: attachment site; inverted papilloma; location; recurrence rates; sinonasal papilloma; sinonasal tumor; surgical treatment; treatment type.

Publication types

  • Systematic Review

MeSH terms

  • Endoscopy / methods
  • Humans
  • Maxillary Sinus
  • Nasal Cavity / pathology
  • Neoplasm Recurrence, Local / surgery
  • Papilloma, Inverted* / pathology
  • Papilloma, Inverted* / surgery
  • Paranasal Sinus Neoplasms* / pathology
  • Paranasal Sinus Neoplasms* / surgery
  • Retrospective Studies
  • Sphenoid Sinus