xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

Role of orbital resection for inverted papilloma

for improved local control. Careful review of preop erative imaging may allow for identification of the hyperostotic focus that usually represents the dominant site of origin. There is evidence to suggest that the same principles apply to attachment sites along the orbit and skull base. Imaging of the site of attachment in inverted papilloma Aggregate grade of evidence C (Level 3: two studies; Level 4: five studies) Benefit Imaging is useful for accurate identification of IP pedicle for preoperative planning. Harm Mild radiation associated with CT imaging as well as contrast burden for CT and MRI images. Cost Associated costs with imaging studies. Benefits–harm assessment Preponderance of benefits over harms. Value judgments Determining site of attachment is imperative for effective surgery and to reduce local recurrence. Policy level Recommendation. Intervention Utilize preoperative CT (as evidenced by

Aggregate grade of evidence

C (Level 4: six studies)

Benefit

Lower recurrence rates with improved orbital preservation. Small potential for orbital injury. Baseline risk of epistaxis and postoperative pain.

Harm

Cost

Associated costs with surgery.

Benefits–harm assessment

Preponderance of benefits over harms.

Value

Determining involvement of orbit on preoperative imaging is helpful for preoperative planning and patient counseling. There are limited data to suggest that lamina resection may lead to orbital soft tissue seeding/recurrence.

judgments

Policy level Recommendation. Intervention Perform resection or drilling of hyperostotic focus for orbital IP with lamina papyracea involvement.

Role of skull base resection for inverted papilloma

osteitis) with or without MRI for accurate identification of IP attachment site, which can also be used to guide surgical approach.

Aggregate grade of evidence

C (Level 4: six studies)

Treatment of the site of attachment in inverted papilloma

Benefit

Lower recurrence rates with reduced morbidity. Small potential for intracranial and/or dural injury and CSF leak. Baseline risk of epistaxis and postoperative pain.

Aggregate grade of evidence

C (Level 4: seven studies)

Harm

Benefit

Lower recurrence rates with reduced morbidity. Baseline risk of epistaxis and postoperative pain.

Cost

Associated costs with surgery.

Harm

Benefits–harm assessment

Preponderance of benefits over harms.

Cost

Associated costs with surgery.

Value

Determining involvement of skull base on preoperative imaging is helpful for preoperative planning and patient counseling, especially if at risk for CSF leak. There are limited data comparing judicious cautery (e.g., bipolar) versus direct resection of the skull base. Furthermore, there are limited data to suggest that skull base resection may lead to intracranial seeding/recurrence.

judgments

Benefits–harm assessment

Preponderance of benefits over harms.

Value

The surgeon must attempt to identify the attachment site in order to properly resect this region to minimize risk of recurrence.

judgments

Policy level Recommendation. Intervention Perform pedicle-oriented resection via any

surgical approach in order to definitively address primary site and reduce recurrence risk. Definitive treatment may entail cauterization or drilling of the pedicle following mucosal resection.

Policy level Recommendation. Intervention Perform endoscopic and/or open resection of skull base IP with bony resection, drilling, or cauterization of mucosal rests to adequately address pedicle. ∙ The indications for RT into treating IP are limited, and are considered for unresectable disease, poor surgical