The endoscopic approach to IP management appears to offer an alternative to direct visual or external ablative techniques. Regardless of the approach, the experience of the surgeon plays a major role in successful outcome. Recurrence after initial endoscopic removal of IP warrants strong consideration for an external approach. The use of irradiation in the treatment of IP should be reserved for recurrent aggressive tumors, including multiple recurrences and squamous cell cancer changes. Perhaps in the future, molecular markers such as HPV type-specific primers and p53 detected on biopsies and margins will help guide the aggressiveness of our treatment.

Panje and Allegretti—CHAPTER 4

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Inverting papilloma is a benign tumor of the nose and paranasal sinuses, which in a small percentage of patients can convert into or hide an associated squamous cell carcinoma. If not completely removed, inverting papilloma will recur and long-term tumor control may become a problem. This lesion has a tendency to move from one sinus to another, requiring that adjacent sinuses be checked for spread of tumor. Therefore, inverting papilloma must be completely removed using surgical principles of tumor removal. The "gold standard" for the treatment ofinverting papilloma affecting the maxillary and ethmoid sinuses is the extranasal medial max-illectomy. This standard was largely established before the advent of endoscopic nasal and sinus surgery. However, considering the improved lighting and visualization provided by the endoscope, along with current state-of-the-art imaging techniques, it can be argued that there is a role for endoscopic diagnosis and treatment in the management of inverting papilloma, hence the controversy— gold standard extranasal medial maxillectomy versus endoscopic techniques for intranasal excision of inverting papilloma.

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