Ear, Nose and Throat (Otolaryngology) – Head and Neck Surgery

Inverted Papillomas

Mount Sinai’s Division of Rhinology and Skull Base Surgery has long been recognized as a leader in the field of complex sinus surgery. Consistently at the forefront of medicine, our team offers state-of-the-art minimally invasive treatments for a variety of conditions including complex and rare tumors like inverted papillomas. Our highly-skilled rhinologists specialize in treating these tumors at all stages and utilize techniques to optimize patient outcomes and minimize complications and recurrence of symptoms.

Multidisciplinary Approach at Mount Sinai

Every case is unique. Mount Sinai physicians work closely with other specialties to develop an individualized treatment for each patient. In certain highly complex cases involving the base of the brain or the bone surrounding the eye, we work closely with our colleagues in neurosurgery and ophthalmology to remove the tumor safely and effectively.

About Inverted Papillomas

Inverted papillomas are benign tumors found in either the mucous that lines the nose or the paranasal sinuses, the four air-filled spaces that surround the nasal cavity under, above, and between the eyes. These tumors, which grow inward toward the bone in fingerlike projections, affect nearly 2 in every 100,000 people and are seen most often in middle-aged men. Physicians do not know what causes inverted papillomas to grow; however, there is some evidence that the human papilloma virus (HPV) plays a role.

Symptoms of Inverted Papillomas

Many cases of inverted papillomas do not cause any symptoms and are discovered accidentally during an evaluation for a different problem. Patients who do report signs typically experience nasal congestion or obstruction, drainage or post-nasal drip, nose bleeds, a decreased sense of smell, or facial pain.

Inverted Papillomas and Cancer

The majority of inverted papillomas are not cancerous. In some 5-15 percent of cases, inverted papillomas can harbor a common form of skin cancer called squamous cell carcinoma. Although inverted papillomas will not metastasize to other areas of the body, they do have a tendency to be locally aggressive. Since they grow inward, inverted papillomas can cause destruction to the bone around the sinuses, eyes, or between the brain and the sinus, particularly if left untreated.

State-of-the-Art Diagnostic Tools at Mount Sinai

Rhinologists at Mount Sinai use the latest technologies to diagnose inverted papillomas, including:

  • Nasal endoscopy - When patients come in for an evaluation, our physicians look for tumors using an endoscope—a narrow tube with a small, flexible camera that passes easily through the nose and sinuses. Images of the inside of these cavities are viewed, magnified, and studied on a large screen.
  • Imaging scans - If an inverted papilloma is found or suspected, patients are typically asked to have a CT or MRI scan. These advanced imaging tools can determine if the tumor has caused damage to any surrounding bone or tissue.
  • Biopsy - In some cases, a biopsy is also needed to confirm diagnosis. During the nasal endoscopy, a small forceps tool is inserted through the tiny tube and used to obtain a sample of the tumor for evaluation.

Nasal Endoscopic Surgical Approach

Inverted papillomas must be treated. The tumor will not go away on its own, and over time it may cause damage to the surrounding bone and tissue. Surgical removal is the only option.

In the majority of cases, surgery can be performed with a minimally invasive procedure called an endonasal endoscopy. The endoscope allows the surgeon to visualize the tumor. Tools similar to forceps that fit through the tube are then used to remove the tumor’s stalk—the area where it attaches to the bone, much like the trunk of a tree. Once the stalk is removed, the surgeon treats the underlying bone to prevent the tumor from growing back.

In rare cases when the surgery cannot be safely completed, or there is cancer found within the tumor, the patient may be offered chemotherapy or radiation. However, this is not routine in most cases of inverted papilloma.

Benefits of Endoscopic Surgery

  • Shorter hospital stay — Endoscopic surgery is an outpatient procedure, which means patients do not need to spend the night the hospital. If stable, the patient can leave a few hours after the procedure and recover in the comfort of her/his own home.
  • No external incisions and shorter recovery — Since endoscopic surgery is performed using a tube that is inserted through the nose there is no external incision on the face that needs to heal or could cause scarring or disfigurement. Patients who have minimally invasive surgery are back to work and physical activity faster than those who have traditional surgery.
  • Improved outcomes – Research shows endoscopic surgery has a lower recurrence rate than traditional surgery.

Follow-up Care

Inverted papillomas can reoccur. In fact, approximately 20 percent of inverted papillomas grow back in the first several years. Surgical precision is key to preventing recurrence.Our operating rooms are equipped with state-of-the-art navigational tools that help guide the surgeon to the exact location of the tumor. We also utilize 3-D navigation and modeling techniques to help pinpoint the entire area of the tumor during the surgery itself. Patients are carefully followed and evaluated by physicians for at least 3 to 5 years after treatment to monitor for and assess any potential recurrence.