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​Inverted Papilloma

Inverted papillomas arise in the nasal cavity and paranasal sinuses and are benign, yet localized aggressive tumors. It is usually diagnosed in patients who have had sinusonasal infections in the past.

Learn about the treatment options for Inverted Papilloma at the UPMC Pituitary Center of Excellence.

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What is Inverted Papilloma?

Inverted papillomas are nasal tumors that originate in the mucosal membrane 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, often recur, and can become malignant (cancerous).

Squamous cell carcinoma is the most common malignancy associated with inverted papillomas.

Symptoms of inverted papillomas may include:

  • Runny nose
  • Nasal obstruction
  • Sinus infections
  • Headaches
  • Facial pain

At UPMC, the preferred surgical treatment for inverted papilloma is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. Surgeons can then remove the inverted papilloma. Benefits of EEA include:

  • No incisions to heal
  • No disfigurement
  • Faster recovery time

Diagnosing Inverted Papillomas

Most inverted papillomas can be found during a physical examination of the nasal and sinus cavities. They have a reddish-grey appearance and may bleed when touched.

The septum may be bowed by the mass of the inverted papilloma. Facial swelling and proptosis (bulging of the eyes) may accompany lesions that have expanded considerably.

Symptoms of inverted papillomas

During the physical exam, your doctor will ask about any symptoms you are having.

Symptoms of inverted papilloma may include:

  • Nasal obstruction, usually one-sided
  • Rhinorrhea (runny nose)
  • Epistaxis (nosebleed)
  • Sinusitis
  • Facial pain
  • Loss of sense of smell
  • Frontal headache

Imaging and radiology testing to diagnose inverted papillomas

Imaging studies 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.

Biopsy is necessary to make a definitive diagnosis.

Inverted Papilloma Treatment


Surgery is the primary treatment for inverted papillomas. Because of the high recurrence rate (40 to 80 percent), early, aggressive surgery to remove the papilloma usually is recommended.

Minimally invasive surgery and removal

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 allows surgeons to access the tumor through the natural corridor of the nose, without making an open incision. Surgeons then remove the inverted papilloma through the nose and nasal cavities.

EEA offers the benefits of no incisions to heal, no disfigurement, and a faster recovery time.

Endoscopic approaches such as EEA have good success rates in preventing recurrence and better cosmetic outcomes than traditional open surgical approaches.