An inverted papilloma arising from the lateral nasal wall at the middle meatus has the characteristic feature of inverted growth into the subepithelial stroma. The risk of malignant transformation to squamous cell carcinoma and the surgical approach of choice are:
- A 10% risk; lateral rhinotomy (external approach)
- B 10–15% risk; endoscopic medial maxillectomy with complete removal of origin site ✓
- C 5% risk; polypectomy via intranasal route
- D 40–50% risk; total maxillectomy for all cases
Explanation
Schneiderian (sinonasal) inverted papilloma has a 10–15% risk of synchronous or metachronous squamous cell carcinoma transformation. The hallmark is inverted (endophytic) growth into the underlying stroma, with characteristic columnar/ciliated to squamous epithelium transition. HPV 6, 11 are associated. The current standard of care is endoscopic medial maxillectomy (Sturman-Canfield procedure endoscopically), removing the entire lateral nasal wall including the site of origin, which significantly reduces recurrence (recurrence rate 5–10% with endoscopic vs. 15–20% with external). Simple polypectomy has an unacceptably high recurrence rate (up to 70%). Lateral rhinotomy is reserved for extensive disease beyond endoscopic reach.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.