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Endophytic (Inverted) Papilloma of the Nose
Right Nasal Chamber
Combined Endoscopic and Caldwell-Luc Approach
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| 1. Preoperative view. The region from which a biopsy was taken is seen.. | 2. Reducing the bulk of the tumor with forceps. |
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| 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). |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 25. Working at the lateral wall. | 26. Elevation of the tumor from the rest of the anterior wall of the antrum. |
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| 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. |
