Diagnosis and Management of Sinonasal Papillomas

PROGRAM DESCRIPTION: Sinonasal papillomas encompass a diverse group of lesions with distinct clinical and histopathological features which impact management and prognosis. Terminology, histology, and treatment of the different types of sinonasal papillomas may be confusing. In this course we will review the subtypes of Schneiderian papillomas based on the 1991 definitions from the World Health Organization: exophytic, oncocytic, and inverted. The incidence, clinical presentation, and histopathological characteristics of each subtype will be discussed. It is important to differentiate and identify exophytic, inverting, and oncocytic papillomas in order to plan appropriate treatment. Appropriate and tailored surgical treatment options will be evaluated in the context of a literature review to improve results and outcomes. The spectrum of surgical approaches, including extended endoscopic and open techniques, will be described and demonstrated with video. Papilloma primary sites in the maxillary, ethmoid, frontal and sphenoid sinuses require distinct surgical techniques. An interactive, multimedia, case-based format will be utilized to highlight distinguishing features that may assist in predicting papilloma subtype and influence surgical planning. Audience response questions will be implemented to facilitate participation. Adjuvant and experimental treatments for refractory papillomas will also be discussed. The role of high-risk HPV in malignant transformation of inverted papilloma will be reviewed. Recommendations for surveillance of patients after surgery for inverted papilloma will be examined.