CT imaging of inverted papilloma of the paranasal sinuses.
This elderly patient presented with left nasal obstruction. On examination, there was a fleshy mass in the left nasal cavity. The anatomy was distorted from previous surgery on his sinuses 40 years earlier. The CT scan showed a soft tissue mass involving the left maxillary sinus, left ethmoid and left frontonasal duct. There was also erosion of the floor of the anterior cranial fossa and left medial orbiral wall. On Histopathology, a biopsy of the nasal mass was diagnosed as inverted papilloma.
A Weber-Ferguson incision was used to carry out a medial maxillectomy via a lateral rhinotomy. This incision also allowed access to the ethmoid (external ethmoidectomy) and the frontal sinus as well.
A lateral rhinotomy provided access to the tumor, the lateral wall of the nasal cavity and maxilla. A medial maxillectomy was then carried out. The ethmoid sinus and frontonasal duct were also accessible from this incision. The inverted papilloma was completely removed. The anterior cranial fossa dura was exposed, but was not involved. The wound was closed with a deep layer of 4-0 Vicryl and the skin with fine absorbable sutures. The lower picture, taken one month post-operatively shows a good cosmetic result and a barely visible scar.
Bechara Y. Ghorayeb, MD
Otolaryngology-Head & Neck Surgery
1140 Business Center Drive, Suite 560. Houston, Texas 77043