Karpishchenko S.A., Zubareva A.A., Vereshchagina O.E., Baranskaya S.V., Voloshina A.V., Bibik P.R. Diagnosis and treatment of synonasal inverted papillomas: our experience. Head and neck = Head and neck. Russian Journal. 2018;6(4):20–27 (in Russian).
Evaluation of clinical and radiological features of sinonasal inverted papillomas (IP) according _ to the cone-beam computed tomography (CBCT) data for improving the quality of diagnosis and planning of surgical intervention.
Material and methods. Case histories and CBCT data of 44 patients (27 men, 60% and 17 women, 40%) aged from 19 to 77 years with a histologically verified IP were analyzed. All these patients underwent endoscopic endonasal surgery in the department otorhinolaryngology at Pavlov’s First Saint-Petersburg State Medical University from 2008 to 2017. The presence of the nasal cavity and paranasal sinuses shadow, its homogeneity and division specifics, as well as the integrity of bone structures and the presence of hyperostosis and osteitis foci were assessed. A comprehensive assessment of the radiographic and symptomatic data was carried out.
Results. The leading symptoms were the unilateral nasal obstruction (26 patients, 59.1%), and the recurrent purulent nasal cavity and paranasal sinuses inflammation (20 patients, 45.5%). Thirty eight patients (86.4%) noted a periodic serous or purulent discharge from the nose. Fourteen patients (31.8%) reported a decreased or complete smell loss for a long time. Two patients (4.6%) did not present any otorhinolaryngological complaint, the pathological content of paranasal sinuses was revealed during dental interventions preparation. During CBCT data evaluation of 44 patients, a one-sided shadow of the nasal cavity and ethmoid cells was registered in 18 (40.9%) cases; the left maxillary sinus had shadow in 8 (18,2%), and the right one in 7 (15,9%). Nasal cavity and adjacent maxillary sinus on the one side were shaded in 7 (15,9%), and in 3 cases (6.8%) a one-sided shading of the nasal cavity coming from the nasal septum was noted. In one case (2.3%) the one-sided involvement of all sinuses was determined. The data obtained correspond to the literature data. Out of 44 cases, the process was unilateral in 81.2% of cases, while subtotal bilateral shading of the nasal cavity and paranasal sinuses was observed in 8 cases (18.2%). In the case of unilateral shading, the above mentioned X-ray characteristics in their various combinations were detected in 33 patients (75.0%). In all 8 cases of bilateral shading of the nasal cavity and paranasal sinuses, the thinning of the bone bulks of the ethmoid cells, as well as the increased radiological density were noted in 5 cases (11.4%), and the thinning of osteomeatal complex bone structure was observed in 4 cases (9.1%). Conclusion. A thorough analysis of CBCT data and the comparison of clinical data allows for IP diagnosis suspecting in patients with long-term symptoms of nasal obstruction and/or a recurrent purulent inflammation of the nasal cavity and paranasal sinuses. However, the main method of diagnosis is histological examination of biopsy specimens.
Key words: sinonasal inverted papilloma, cone-beam computed tomography, FESS
The authors declare no conflict of interest.
Source of financing: not specified.
For citation: Karpishchenko S.A., Zubareva A.A., Vereshchagina O.E., Baranskaya S.V., Voloshina A.V., Bibik P.R. Diagnosis and treatment of synonasal inverted papillomas: our experience. Head and neck = Head and neck. Russian Journal. 2018;6(4):20–27 (in Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.