Inverted papillomas are benign, localized, aggressive tumors that arise in the nasal cavity and paranasal sinuses. They are usually diagnosed in patients with a history of sinus infections. Early surgery is the most common treatment method for inverted papilloma, as the condition is known to recur.
On this page:
What Is Inverted Papilloma?
Inverted papillomas are nasal tumors that originate in the mucosal membranes of the nasal cavity and paranasal sinuses.
Papillomas are benign epithelial tumors that grow outward in fingerlike projections in the nose. In inverted papillomas, these projections grow inward and into the underlying bone. These tumors are locally aggressive and often recur.
While most are benign (noncancerous), they can become malignant (cancerous).
Squamous cell carcinoma, a type of skin cancer, is the most common malignancy associated with inverted papillomas.
These nasal growths typically begin growing near the thin bone that divides the nose into the left and right cavities. Rarely, they are found in the middle ear, tear ducts, and throat.
What are the stages of inverted papilloma?
Doctors use a common four-part staging system for inverted papilloma:
- Stage I — The growth remains inside the nasal cavity.
- Stage II — The growth has spread behind or beside the nose.
- Stage III — The growth has extended into the cheeks, forehead, or skull.
- Stage IV — The growth has extended beyond the sinus region or is showing clear signs of cancer.
How common is inverted papilloma?
Inverted papilloma is relatively rare — making up less than 0.5% of all nasal tumors in the United States.
What causes inverted papilloma?
Experts aren’t exactly sure what causes inverted papillomas to form, but they know that some occupational exposures and chronic conditions can contribute.
Inverted papilloma risk factors
You are at a higher risk for inverted papilloma if you:
- Are a middle-aged man.
- Have chronic inflammation or sinusitis.
- Have HPV.
- Have severe allergies.
- Smoke tobacco.
- Work in an environment with exposure to harsh chemicals or substances.
Complications of inverted papilloma
If left untreated, inverted papillomas may become cancerous and life-threatening.
What Are the Signs and Symptoms of Inverted Papilloma?
Symptoms of inverted papilloma often resemble those of chronic sinus infections. Because of this similarity, it’s important to talk with your doctor about your symptoms so you can receive the correct diagnosis and treatment.
Common symptoms of inverted papilloma include:
- Facial pain.
- Frontal headache.
- Loss of sense of smell.
- Nasal obstruction or congestion, usually one-sided.
- Nosebleeds.
- Postnasal drip.
- Runny nose.
- Sinusitis.
Other, less common symptoms associated with inverted papilloma include:
- Bulging or watering eyes.
- Face numbness or asymmetry.
- Problems with speech.
Visible tumors that can be felt under the skin.
When should I see a doctor about my inverted papilloma symptoms?
If you have any of the above symptoms, set up an appointment with your primary care physician. An accurate and timely diagnosis increases the likelihood of a full recovery.
How Do You Diagnose Inverted Papilloma?
First, your doctor will ask you a series of questions about your physical symptoms and health history. They may perform a physical exam to look at symptoms and general functioning.
Next, you can expect your doctor to order diagnostic tests or refer you to an otolaryngologist or ear, nose, and throat (ENT) specialist for further examination.
Tests to diagnose inverted papilloma
Your doctor may order:
- Endoscopy — In this procedure, a long tube with a camera and light on the end is inserted into your nose to examine the tumor. The doctor may also take a biopsy, or small sample of the tumor tissue, to send for cancer testing in a lab.
- Imaging tests — Such as MRI or CT scans help reveal the extent to which the inverted papillomas have spread and the degree of bone destruction. An MRI is preferred because it allows inverted papillomas to be better distinguished from other types of lesions.
How Do You Treat Inverted Papilloma?
Surgery is the primary treatment for inverted papillomas. Because of the high recurrence rate (40% to 80%), early, aggressive surgery to remove the papilloma is usually recommended.
Minimally invasive surgery to treat inverted papilloma
Inverted papillomas of the sinuses, nasal cavity, and skull base may be approached directly using the endoscopic endonasal approach (EEA).
This state-of-the-art, minimally invasive approach – pioneered at UPMC – allows surgeons to access the tumor through the natural corridor of the nose, without an open incision. Surgeons then remove the inverted papilloma through the nose and nasal cavities.
EEA offers the benefits of:
- Faster recovery time.
- No disfigurement.
- No incisions to heal.
Endoscopic approaches, such as EEA, have good success rates in preventing recurrence and offer better cosmetic outcomes than traditional open surgical approaches.
