Therapy of inverted papilloma via an endoscopic transnasal Denker approach

Inverted papillomas are benign tumors of the sinunasal mucosa originating from the Schneiderian membrane. Due to the high risk of recurrence and malignancy, therapy focusses on extended resection and the ability for a safe local control in follow-up. The modified endoscopic Denker approach is a combination of a classical functional endoscopic sinus surgery (FESS) extended by a medial maxillectomy and the resection of the anterior column of the pyriform aperture.

132 patients with inverted papillomas have been operated on in our department in the past 15 years. 74 surgeries have been performed via an endoscopic Denker approach for primary treatment. In follow-up four cases of recurrence and two malignant transformations were found. The clinical course as well as the diagnostic and therapeutic strategies for this tumor are elucidated with a focus on the detailed surgical steps.

Conclusion:

Despite the low rate of local recurrence (5%) and malignancy (3%) in this series, it is of great importance in surgery on inverted papilloma to reach adequate radical removal of the disease as well as to generate access for a clear endoscopic follow-up. These goals can be achieved reliably via the endoscopic Denker approach.

Publication History

Publication Date:
18 April 2018 (online)