Endoscopic resection of nasal cavity-sinus inverted papilloma

Inverted papilloma is a benign tumor, but it has a destructive growth pattern, rapid development, easy recurrence after surgery (recurrence rate is as high as 25% to 75%), and high malignant rate (2%). Therefore, it is often treated as a malignant tumor in the clinic, and the tumor should be completely removed after diagnosis. Nasal-sinus inverted papilloma occurs in the lateral wall of the nasal cavity, and the maxillary sinus and ethmoid sinus are the most common. At present, many authors have reported that nasal endoscopic sinus inverted papilloma resection through the nasal cavity under endoscopy has achieved good results. The advantages are: 1. The primary site and the scope of invasion of the tumor can be directly observed under the endoscope, and the visual field is clear, which is conducive to completely resecting the tumor and reducing recurrence. 2. The damage is small, and the normal mucosa can be preserved, which is beneficial to the recovery of nasal function. 3. Facilitate follow-up after surgery. 4. No facial scars. Treatment of diseases: maxillary sinus malignant tumor Indication In the past, endoscopic surgery was applied to the localized nasal cavity, ethmoid sinus and maxillary sinus inversion of the inverted papilloma. With the development of surgical equipment and technology, in addition to the case of maxillary resection, it is generally available. Endoscopic surgery is completed. Contraindications Malignant transformation of inverted papilloma requires maxillary resection. Preoperative preparation 1. Detailed nasal endoscopy. 2. Nasal-sinus coronal and axial CT scan, if there is skull base bone destruction, MRI should be performed. Surgical procedure 1. Under the endoscope of 30 ° 4 mm, according to the extent of the lesion, first remove the intranasal mass, and then carefully examine the structure of the nasal cavity to determine the extent of the lesion. 2. Excision of the uncinate process to find and enlarge the natural opening of the maxillary sinus. Expand up to the sputum, down to the inferior turbinate, back to the posterior wall of the maxillary sinus, and forward to the tear bone. If the tumor invades the ethmoid sinus, a thorough ethmoidectomy should be performed to remove all tumor tissue. 3. In order to prevent recurrence, the middle turbinate should also be removed. If the tumor invades the sphenoid sinus, the anterior wall of the sphenoid If CT shows an increase in frontal sinus density, the nasal foramen should be opened. The tumor invaded the sinus less, and more invaded the nasal foramen. If there is a mass in the nose tube, it can be scraped off with a curette. 4. To completely remove the inner wall of the maxillary sinus and the maxillary sinus, the maxillary sinus wall can be removed along the maxillary sinus stoma of the middle nasal passage, backward to the posterior wall of the maxillary sinus, up to the base of the sinus, down to the inferior turbinate, forward to Nasal lacrimal duct. Excision of the inferior turbinate using an electric drill or rongeur to remove the lateral wall of the lower nasal passage to the nasal floor. The tumor and mucosa in the maxillary sinus were scraped off with a curette at 30° and 70°. For example, it is difficult to treat the lesion of the anterior wall of the maxillary sinus. For inverted papilloma of the maxillary sinus or extensively invading the maxillary sinus, it is difficult to completely remove the tumor under endoscopic surgery. If the anterior wall of the maxillary sinus is to be removed or the bleeding is fierce and cannot be completely removed, it should be Surgery such as nasal incision can be performed at any time. Endoscopic surgery can be combined with traditional surgery (maxillary sinus radicalization, nasal incision). For recurrent cases, postoperative radiotherapy can be used.

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