2023 Volume 62 Issue 4 Pages 625-630
Inverted papilloma (IP) should be assumed to be present preoperatively in cases with suspicious findings, and requires surgical resection with a sufficient margin and base treatment. Here, we report a case of IP overlapping odontogenic maxillary sinusitis that required careful treatment.
A 62-year-old man was referred to our department due to lack of improvement on computed tomography (CT) of a shadow in the left maxillary sinus after tooth extraction and cleaning by our oral surgery department for left odontogenic maxillary sinusitis. CT showed soft tissue density localized in the left maxillary sinus, and conservative treatment with clarithromycin and carbocysteine was administered for three months; however, the shadow in the left maxillary sinus remained on CT and only showed mild improvement. IP was suspected based on localized bone thickening of the outer wall of the left maxillary sinus and the shape of the soft shadow, but biopsy was difficult because of the tumor localization. Contrast-enhanced magnetic resonance imaging (MRI) showed a convoluted cerebriform pattern, leading to a preoperative diagnosis of IP. Endoscopic modified medial maxillectomy (EMMM) was performed under nasal endoscopy, and the tumor was removed with a sufficient margin and base treatment. Postoperative pathological examination revealed a diagnosis of IP. At one year and five months postoperatively, the patient had no recurrence. These findings show that IP may be present in a case with a diagnosis of odontogenic maxillary sinusitis, and that IP should be assumed preoperatively based on suspicious findings, such as localized bone thickening. Biopsy may be difficult for IP confined to the maxillary sinus, and CT and MRI are useful for preoperative diagnosis.
