전두동 및 전두와에 발생한 반전성 유두종에 대한 수술접근법의 선택

Background and Objectives: Surgical approach for removal of inverted papilloma (IP) originating from the frontal sinus (FS) and frontal recess (FR) depends on the sites of tumor origin. This study was designed to evaluate limitations and indications of endoscopic excision of IP and to know the appropriate surgical approach according to IP origin site in the FS or FR extending spatially into the FS. Patients and Methods: Twelve patients with IP originating from the FS and FR, who had got surgery at Department of ORL, Pusan National University Hospital from 1996 to 2004, were retrospectively reviewed in the aspects of tumor origin site, approach method, recurrence, mode of reoperation after recurrence, and complications. The mean age was 50.5 years with a male-to-female ratio of 10 : 2. The average duration of the follow-up period was 42.4 months. Results: Among 5 cases of IP originated from the FS, 4 cases were recurred. Two cases who showed extensive whole wall origin and anterior wall origin of the FS were reoperated by the osteoplastic frontal sinus surgery, and one cases who showed FS septum origin was reoperated by modified endoscopic Lothrop operation. One case who had posterior wall origin was successfully removed by endoscopic surgery only. All 7 cases who showed FR origin were treated with endoscopic surgery only except one case of recurrence. The recurred IP in the FR was removed by simple touch-up procedure under endoscopy. Conclusion: IP originating from the FR can be successfully removed by endonasal endoscopic surgery only. Endoscopic surgery with or without trephination could be applied as a first-line treatment for IP originating from the posterior wall of the FS. IP originating from the FS septum could be removed by modified endoscopic Lothrop operation. However, IP originating from anterior wall, lateral wall, or whole wall needs osteoplastic frontal sinus surgery for complete removal. (J Clinical Otolaryngol 2006;17:228–233)