Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.
Humans ; Papilloma, Inverted/pathology* ; Endoscopy ; Maxillary Sinus/pathology* ; Lacrimal Apparatus/surgery* ; Treatment Outcome ; Retrospective Studies

OBJECTIVES: Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures. METHODS: Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed. RESULTS: Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications. CONCLUSION: In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.
Animals ; Beak ; Drainage ; Endoscopy ; Frontal Sinus* ; Humans ; Mucocele ; Nasal Septum ; Osteoma ; Papilloma, Inverted ; Pathology* ; Retrospective Studies

According to the classification of World Health Organization, papillary squamous cell carcinoma is a variant of squamous cell carcinoma. This is a malignancy rarely found in the upper aerodigestive tract, especially in the sinonasal tract. We experienced a case, in which a 50-year-old man had papillary squamous cell carcinoma on his right nasal cavity, accompanied with inverted papilloma and fungiform papilloma. They were resected via endoscopic and Caldwell-Luc's approach. After the operation, the patient was treated with radiotherapy for 7 weeks, and has been disease-free for two years. We present the clinical characteristics, pathology, treatment, and prognosis of the tumor with a review of the literature.
Carcinoma, Papillary ; Carcinoma, Squamous Cell* ; Classification ; Humans ; Middle Aged ; Nasal Cavity ; Nose ; Papilloma ; Papilloma, Inverted* ; Paranasal Sinuses ; Pathology ; Prognosis ; Radiotherapy ; World Health Organization

OBJECTIVE: To investigate the application of endoscopic nasal lateral wall dissection in lesions of the maxillary sinus. METHOD: Ten hospitalized patients with the maxillary sinus lesions were treated with the endoscopic nasal lateral wall dissection. RESULT: All 10 patients were unilateral invasion. Among them, 7 cases were inverted papilloma, 2 cases were recurrent antrochoanal polyps, 1 case was sinusal tooth. The tumors and antrochoanal polyps originated from the every part of the maxillary sinus wall during operation, especially from the anterior and media wall. During 10-62 months follow-up,epithelization of nasal occured and the shape of inferior turbinate was well. All of them had no epiphora. CONCLUSION Endoscopic nasal lateral wall dissection can remain the function of nasal lacrimal duct and nasal cavity,and may provide a new minimally invasive approach for complete resection of lesions of nasal cavity and the maxillary sinus.
Dissection ; Endoscopy ; Humans ; Lacrimal Apparatus ; Maxillary Sinus ; pathology ; Nasal Cavity ; Nasal Polyps ; surgery ; Papilloma, Inverted ; surgery ; Turbinates

OBJECTIVE: To summarize the clinical characteristics and treatments of patients with malignant transformation of sinonasal inverted papilloma (SNIP), and to explore the factors influencing the prognosis of malignant SNIP. METHOD: To retrospectively analyze the clinical data of 35 patients with malignant SNIP. The prognosis affected by age, gender, pathogenetic locations, pathology, clinical stages and treatments were analysed using Kaplan Meier, Log rank and Cox method. RESULT: In our research, 5 years survival rate was 68.6% in malignant SNIP. There were 3 factors effecting the 5 years survival rate of malignant SNIP: clinical staging, histopathological features and treatments while gender, age, disease location, and percentage of the malignant cell in the entire tumor tissue had no effect on overall survival rate. Clinical staging and treatment were the independent factors that influenced the prognosis of malignant SNIP (P value was 0.019 and 0.006). CONCLUSION Risk factors that independently influence the survival of patients with malignant SNIP were the clinical staging and treatment. The degree of histo pathological features can be the secondary indicator to judge the prognosis of malignant SNIP. Endoscopic surgery or comprehensive therapy performed on patients properly is therapeutically effective.
Cell Transformation, Neoplastic ; Endoscopy ; Humans ; Nose Neoplasms ; diagnosis ; pathology ; Papilloma, Inverted ; diagnosis ; pathology ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVE: To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. METHOD: Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). RESULT: Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. CONCLUSION Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.
Cerebrospinal Fluid Leak ; surgery ; Endoscopy ; instrumentation ; Fibroma, Ossifying ; surgery ; Humans ; Nasal Surgical Procedures ; methods ; Neurosurgical Procedures ; Nose ; pathology ; Papilloma, Inverted ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Sinusitis ; surgery ; Sphenoid Bone ; pathology ; Surgery, Computer-Assisted ; methods

OBJECTIVE: To evaluate the prognosis of Draf II b surgery in treating fontal sinus inverted papilloma. METHOD: A retrospective study was carried out among 15 patients diagnosed as fontal sinus inverted papilloma, which had underwent endoscopic Draf II b surgery. The clinical success rate and surgical success rate were calculated by survival analysis. RESULT: In all patients, there were 1 (6.67%) recurrence,1 (6.67%) stenosis, 4 (26.67)% complete closure, and 1 (6.67%) mucocele cyst. The 3-year clinical success rate was 93.3%, and the 3-year surgical success rate was 65.0%. CONCLUSION Draf II b surgery is feasible when the frontal sinus inverted papilloma is involved in the area of the pupil center line, and the frontal neo-ostium stenosis or complete closure is a common complication after surgery. Thus a close follow-up is recommended during the first year after the surgery. Further study is necessary to find a better way to reduce the complication rate.
Constriction, Pathologic ; pathology ; Endoscopy ; Frontal Sinus ; pathology ; Humans ; Mucocele ; pathology ; Nasal Surgical Procedures ; methods ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Postoperative Complications ; pathology ; Prognosis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

BACKGROUNDDistinguishing inverted papilloma (IP) from malignant tumors in the nasal cavity is difficult in a substantial number of cases, thus hindering the administration of appropriate therapeutic strategies. This study aimed to evaluate whether magnetic resonance imaging (MRI), including dynamic contrast enhanced MRI (DCE-MRI), could improve differentiation between IP and malignant tumors, and to identify which MRI features were the best in discriminating IP from malignant tumors in the nasal cavity.

METHODSNon-enhanced, static, and dynamic contrast enhanced MRI was performed in 88 patients with an IP or a malignant tumor in the nasal cavity that had been confirmed by histological results. MRI features of IP and malignant tumors including side, margin, T1 signal intensity, T1 homogeneity, T2 signal intensity, T2 homogeneity, lobulation signs, convoluted cerebriform pattern, extra-sinonasal involvement, pattern of enhancement, Tpeak, Tmax, CImax, and TIC type were evaluated and correlated with histological findings.

RESULTSThere were significant differences between IP and malignant tumors in T2 homogeneity, lobulation signs, convoluted cerebriform pattern, extra-sinonasal involvement, Tpeak, Tmax and TIC types. A convoluted cerebriform pattern had a higher sensitivity and specificity in diagnosis of IP while washout-type TIC had a higher sensitivity and specificity in diagnosis of malignant tumors in the nasal cavity. Non-enhanced combined with static and dynamic enhancement MRI was significantly superior to non-enhanced combined with static enhancement MRI in the differentiation of IP and malignant tumors in the nasal cavity. Multivariate logistic regression analysis identified that the best MRI features were a convoluted cerebriform pattern, extra-sinonasal involvement, and washout-type TIC for both observers (Wang XY and Zhang ZY).

CONCLUSIONNon-enhanced and static combined with dynamic contrast-enhanced MRI improves differentiation of IP and malignant tumors in the nasal cavity.

Adult ; Aged ; Contrast Media ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Nose Neoplasms ; diagnosis ; Papilloma, Inverted ; diagnosis

OBJECTIVETo investigate the expression and clinical significance of phosphatase and tensin homology deleted on chromosome ten (PTEN) and hypoxia-inducible factor 1 alpha (HIF-1α) in sinonasal inverted papilloma (SNIP) of different pathological grades.

METHODSFifty-five paraffin samples from patients with SNIP and a control group of 10 paraffin samples of patients with normal nasal cavity mucosa (NM) who underwent inferior turbinectomy were consisted in this study. Among the 55 cases of SNIP, 30 cases were without dysplasia subtypes, 11 cases were with dysplasia subtypes, and 14 cases with canceration to squamous cell carcinoma (SCC) subtypes. PTEN and HIF-1α expression in SNIP was detected by immunohistochemistry. The differences between NM and SNIP, and among the three subtypes were analyzed, and the relationship between PTEN, HIF-1α expression and SNIP recurrence and the correlation between PTEN expression and HIF-1α expression were also analyzed. SPSS 16.0 software was used to analyze the data.

RESULTSThe positive expression rate of PTEN in NM and SNIP was 100% and 65.5%, the difference was significant (U = 147, P = 0.014), while HIF-1α was 0 and 30.9%, the difference was significant (U = 190, P = 0.045). The positive expression rate of PTEN in SNIP without dysplasia, SNIP with dysplasia and NSCC was 83.3%, 63.6%, 28.6%, respectively, the difference was significant (H = 12.644, P = 0.002); while HIF-1α was 16.7%, 45.5%, 50.0%, respectively, the difference was significant (H = 8.292, P = 0.016). A total of 22 SNIP patients recurred. PTEN had lower expression in recurrent SNIP (45.5%) than that in non-recurrent SNIP (82.8%), and the difference was significant(χ² = 7.834, P = 0.005). However, the expression of HIF-1α had no significant difference between recurrent SNIP and the SNIP which had no recurrence (χ² = 0.901, P = 0.343). The expression of PTEN protein was negatively correlated with that of HIF-1α protein (r = -0.503, P = 0.001).

CONCLUSIONSPTEN expression decreased graduately with the severity of malignancy of SNIP, but HIF-1α increased. The expression of HIF-1α was induced by hypoxia, which may negatively effect the expression of PTEN, and both HIF-1α and PTEN may play critical roles in the progress of SNIP. PTEN is one of the factors responsible for the postoperative recurrence of SNIP.

Adult ; Aged ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Nose Neoplasms ; metabolism ; pathology ; PTEN Phosphohydrolase ; metabolism ; Papilloma, Inverted ; metabolism ; pathology ; Paranasal Sinus Neoplasms ; metabolism ; pathology

OBJECTIVE: To assess the therapeutic effect and study the role of nasal mucosa epithelization after endoscopic surgery using the plasma radiofrequency ablation at low temperature in patients with nasal inverted papilloma. METHOD: The clinical data of 104 patients with nasal inverted papilloma underwent endoscopic surgery u sing the plasma radiofrequency ablation at low temperature from July, 2008 to July, 2012 were analyzed,and the recovery of mucosa was observed under nasal endoscope. RESULT: The mucosa recovery extent showed a decreasing trend from mucosa pattern degree I to III, where the difference was statistically significant by chi-square test between groups (P < 0.05). The average epithelialization time was 2.7 months. It showed a significantly decreasing trend among average epithelialization time of different degrees of mucosa (P < 0.05). The nasal mucosa of most patients completed epithelialization 2.9 months after surgery. CONCLUSION It is safe and effective to treat nasal inverted papilloma with plasma radiofrequency ablation at low temperature. The patients should be followed up with regular reexamination for at least three months after surgery.
Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; Nasal Mucosa ; pathology ; Nose Neoplasms ; surgery ; Papilloma, Inverted ; surgery ; Postoperative Period ; Retrospective Studies