Clinical Evaluation of Sinonasal Papillomas.

Clinical studies of twenty-four patients with sinonasal papillomas were performed. The cases were classified into three histopathological types: 1) exophytic (fungiform), 2) inverted, and 3) cylindrical cell (columnar cell) papillomas. In this study, inverted papilloma was the most common type. All types of sinonasal papillomas had male predominance. The mean age of patients with inverted papillomas was higher than that of patients with exophytic papillomas. The most common major symptom of exophytic papillomas was a nasal mass and that of inverted papillomas was nasal obstruction. The exophytic papillomas occurred in the nasal septum or the nasal vestibules, whereas the inverted papillomas occurred primarily in the lateral nasal wall and/or in the paranasal sinuses. Exophytic papillomas had a lower recurrence rate than inverted papillomas even though only intranasal tumor resection was undertaken in the former, whereas medial maxillectomy was performed in the latter. The resection range of inverted papillomas should be decided on the basis of the location and the degree of invasion to avoid inadequate excision. This is especially important when the inverted papilloma is located in the ethmoid sinus or on the middle turbinate. In such cases wider excision is needed to prevent recurrences. In our cases, there was no association of malignancy with sinonasal papillomas.