Papiloma schneideriano invertido. Stabilirea diagnosticului de certitudine în tumorile de sinus maxilar - Viața Medicală


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The procedure implies surgical excision of the lateral nasal wall and ethmoid sinus. This technique is aided by the usage of adequate instruments, such as 0° and 70° scopes and angulated surgical in­struments, which allow the complete visualization and access to the maxillary sinus.

The authors present, as an endoscopic surgical atlas, step by step, the surgical procedure for endoscopic approach of inverted papilloma, in order to reach a complete tumor removal without any leftovers.

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Keywords medial maxillectomy, papiloma schneideriano invertido papilloma, endoscopic sinus surgery Rezumat Tehnica maxilectomiei mediale reprezintă standardul de aur în tratamentul chirurgical al papilomului inversat, deoarece oferă o expunere adecvată a peretelul nazal lateral şi a sinusului maxilar. Intervenţia include excizia chirurgicală a peretelui nazal lateral şi a sinusului etmoidal.

Această tehnică este posibilă prin folosirea instrumentarului adecvat, a tijelor de 0° şi 70° şi a instrumentelor chirurgicale angulate, care permit vizualizarea şi accesul complet spre sinusul maxilar.

Source: Romanian Medical Journal. Inverted papilloma is a rare epithelial benign neoplasm which presents a number of significant therapeutic problems due to a high rate of postoperative recurrence and a significant percentage of malignancy.

Autorii prezintă, ca un papiloma schneideriano invertido de chirurgie endoscopică, paşii acestei tehnici chirurgicale de abord endoscopic al papilomului inversat, în vederea exciziei complete a tumorii, fără nicio restanţă.

Cuvinte cheie maxilectomie medială papilom inversat chirurgie sinuzală endoscopică Introduction Inverted papilloma represents an invasive, unilate­ral, papiloma schneideriano invertido tumoral mass, which has its origin in the nasal mucosa and presents a risk of malignancy. It is most commonly located on the lateral nasal wall, extended to the maxillary and ethmoid sinus 1.

PAPILOMUL INVERTIT RINOSINUSAL - TUMORĂ BENIGNĂ CU POTENȚIAL DE MALIGNIZARE.

When it has its origin in the maxillary sinus, the elected technique is papiloma schneideriano invertido by endoscopic medial maxillectomy. Medial maxillectomy aims to enable the access to the maxillary sinus, superior to the combined middle and inferior meatus approach.

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In the last decades, with the development of endoscopic and imagistic techniques, the endoscopic approach replaced the external procedures, as it presents similar success rates, lower morbidity and better esthetic outcomes for the patient 2.

Also, endoscopic approach was proven to allow the better evaluation of nasal mucosa.

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The indications for endoscopic medial maxillectomy include inverted papilloma, nasopharyngeal angiofibroma and pterygomaxillary fossa pathology 3. The diagnostic protocol depends on a computed tomography, which illustrates the extension papiloma schneideriano invertido place of attachment of the tumor.

Prin numeroase studii a fost identificată prezența virusului papiloma uman în mostrele de papilom invertit hibridizate in situ cu sonde de ARN specific subtipurilor virale HPV 6, 11, 16 și La nivelul tumorilor papilare benigne au fost identificate subtipurile 6 și 11, pe când subtipurile 16 și 18 au fost asociate cu degenerarea malignă.

This image shows the left maxillary sinus completely occupied by a tumoral mass, extended to the left nasal fossa, hyperostosis of the maxillary sinus walls and an papiloma schneideriano invertido bony thickening, representing the origin of the tumor Figure 1. Figure 1. CT image, coronal section, showing complete blockage of the maxillary sinus, hyperostosis and tumoral origin arrow The first surgical step includes antero-posterior ethmoidectomy, with the excision of the tumor from this level and from the middle meatus.

We used a piece-meal resection, using bipolar electrocoagulation for hemostasis Figure 2. Figure 2.

papiloma schneideriano invertido

Intraoperative aspect of ethmoidectomy with tumor excision After ethmoidectomy and clearing of the middle meatus, the resection of the inferior turbinate and sinonasal wall is performed.

This technique allows a complete resection of the tumor and a good visualisation of the maxillary sinus extensions Figure 3.

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Figure 3. Endoscopic resection of the inferior turbinate and lateral nasal wall Medial maxillectomy offers an optimal access to the maxillary sinus, with the complete resection of the tumor and the identification of the tumor origin.

  • Stabilirea diagnosticului de certitudine în tumorile de sinus maxilar - Viața Medicală
  • Există trei metode de tratament: chirurgical maxilectomie parţială, maxilectomie totală, maxilectomie totală cu exenteraţie orbitalăradioterapie şi chimioterapie.
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It represents the key point of papiloma schneideriano invertido resection in order to avoid any leftovers Figure 4. Figure 4. The identification of the tumor origin using the 70° scope The deperiostation of the tumor paraziții 2019 is required, as it lowers the risk of recurrence. We can succeed in this procedure papiloma schneideriano invertido an angulated curette Figure 5 or an angulated diamond burr, depending on the position of the bony stalk or hyperostosis.

RMR_Nr-2_2014_Art-6.pdf

Figure 5. The deperiostation of tumor origin Final image of the widely opened medial maxillectomy ostium and resorbable sponge applied in the maxillary sinus.

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This procedure does not require the usage of a hemostatic sponge Figure 6. Figure 6.

Final image with resorbable sponge applied Conclusions Inverted papilloma is a benign tumor with recurrence and malignancy potential. Recurrence is in fact a tumoral residue. The endoscopic medial maxillectomy is the elected technique for complete tumoral resection and ensures a papiloma schneideriano invertido approach to the maxillary sinus and also lowers the risk of recurrence. Conflict of interests: The authors declare no conflict of interests.

Maxilectomia maxilară medială pentru papilomul inversat

Sinonasal inverted papilloma: A case report and mini papiloma schneideriano invertido of histopathological features. Journal of Oral and Maxillofacial Pathology. Cunningham K, Welch K.

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  • EBSCOhost | | PAPILOMUL INVERTIT RINOSINUSAL - TUMORĂ BENIGNĂ CU POTENȚIAL DE MALIGNIZARE.
  • Maxilectomia maxilară medială pentru papilomul inversat
  • Elena Roxana Osiac1, Conf.
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Endoscopic medial maxillectomy. Operative Techniques in Otolaryngology.

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Transnasal endoscopic medial maxillectomy for inverting papilloma. The Laryngoscope.