Different endoscopic options in the treatment of inverted papilloma

According to their extent and location, lesions of the ethmoidal-maxillary complex require different types of resections (types 1-3), which can vary from a simple ethmoidectomy with middle antrostomy, sphenoidotomy and frontal sinusotomy (type 1), to a medial maxillectomy (type 2), up to a Sturmann-Canfield approach (type 3), which gives an excellent visualization of the entire maxillary sinus. Inverted papilloma extensively involving the frontal sinus may pose a challenge to the surgeon. Because even magnetic resonance imaging may fail to identify the pattern of mucosal involvement, the surgeon should be ready to switch intraoperatively from an endoscopic approach to a frontal osteoplastic flap. There are indeed other situations (ie, involvement of a largely pneumatized supraorbital cell, extensive adhesion of the lesion to the dura, transperiorbital spread, presence of massive scar tissue) that may require a combined approach.