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Endophytic (Inverted) Papilloma of the Nose

Right Nasal Chamber

Combined Endoscopic and Caldwell-Luc Approach

1. Preoperative view. The region from which a biopsy was taken is seen.. 2. Reducing the bulk of the tumor with forceps.
3. Within the tumor a polypoid formation is seen probably from the maxillary sinus. 4. After the removal of the polyp, the communication with the antrum is seen (probably anterior fontanelle).
5. Removing pieces from the periphery of the tumor with microdebrider. 6. The debulking of the tumor reveals the middle concha rather free of pathology.
7. Decongestion of the lower concha reveals the extension of the tumor to the nasopharynx. 8. Removing part of the tumor reveals nasopharynx free of pathology.
9. Ongoing debulking of the tumor starts to make clear that it originates from the maxillary sinus. 10. Working in the area of the agger nasi cell in order to inspect the frontal sinus.
11. The enlarged ostium of the frontal sinus is seen and posteriorly the anterior ethmoidal artery. 12. Enlargement of the antrostomy. The posterior wall of the antrum is seen rather free of pathology.
13. Continuing the operation through trephination of the anterior wall of the antrum. 14. View with a 45° endoscope. The tumor seems to originate from the anterior wall of the antrum. The operation will be continued through a Caldwell-Luc approach.
15. Prolapse of the tumor through the Caldwell-Luc. 16. View through the Caldwell-Luc. Elevating the mucosa of the lateral wall of the antrum.
17. The tumor moves freely with the suction but seems firmly attached to the anterior wall of the antrum in an area of osseous projection. 18. The mobile part of the tumor is suctioned outside the antrum for reasons of demonstration.
19. … and is removed by the use of a microdebrider. 20. The removal of the free surface of the tumor alternates with efforts of elevation of the mucosa.
21. Detachment of the buccal soft tissues in the area from which the tumor originates in order to enlarge the Caldwell-Luc’s window. 22. Enlargement of the Caldwell-Luc’s window. The rest of the tumor is seen.
23. Elevation of the mucosa and mobilization of the tumor. The ground of the antrum is seen. 24. Elevation of the mucosa of the roof of the antrum with a curette.
25. Working at the lateral wall. 26. Elevation of the tumor from the rest of the anterior wall of the antrum.
27. The remaining part of the tumor hangs freely inside the antrum along with healthy tissue and polypoid mass. Removal with a microdebrider. 28. During the inspection of the antrum the presence of the horizontal part of the uncinate process is noted and is removed.