Inverted papilloma

Case contributed by Dr Ian Bickle

Presentation

Middle aged female presented with nasal stuffiness thought to represent pan sinusitis.

Patient Data

Age: 47
Gender: Female
CT

Opacification of the left ethmoidal, maxillary and both frontal sinuses.

Widening of the left osteomeatal complex.

Destruction of the bony septae of the left ethmoidal air cells, medial wall of the maxillary sinus and floor of the right side of the anterior cranial fossa, including the posterior wall of the right frontal sinus.

MRI

Enhancing soft tissue in the left nasal canal and ethmoidal sinuses with widening and obstruction of the osteomeatal complex.

The mass extends cranially into both frontal sinuses with destruction of the inner table ( posterior wall ) of the right frontal sinus.

The opacification of the left maxillary sinus in CT is obstructed fluid.

Photo

The histological report for the surgical biopsies confirmed the radiological suspicion of inverted papilloma.

Photo

Stereolithographic Model ( mass indicated in peach colour )

Large left sided ethmoidal mass with intracranial extension invaving the frontal sinuses, medial left orbital wall and floor of the anterior cranial fossa.

Although largely left sided the tumour extends across the midline to involve the right anterior cranial fossa.

CT

Follow up post bilateral frontal craniotomy and left maxillectomy.

Mesh reconstruction of the left medial orbital wall.

No recurrence.

Case Discussion

Sterolithographic modelling, now with 3D printing facilities, is establishing itself as a superb resource in pre-operative planning in several fields, in particular oromaxifacial surgery.

CT and MRI data may be used in the modelling process ( with the appropriate protocols ) as illustrated by this case of a destructive inverted papilloma.

The shaded model indicates the extent of the bony destruction in exquisite detail aiding surgical planning - for example in this case the anterior cranial fossa destruction meaning a combined procedure with neurosurgery is indicated.

The case also illustrates the role MRI has over CT in inverted papillomas in distinguishing papilloma from obstructive fluid.

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Case information

rID: 35065
Case created: 20th Mar 2015
Last edited: 20th May 2017
System: Head & Neck
Inclusion in quiz mode: Included

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