Bilateral aggressive inverted papillomas: A changing scenario.

Objective: The ideal management of bilateral, recurrent inverted papillomas is intriguing and often controversial. We describe the ideal management of such tumors.

Methods: Retrospective, case series Methods: The three patients in this series inspite of several surgical procedures in the past had recurrences and behaved in an aggressive fashion. The patients underwent surgical excision by either bilateral lateral rhinotomy, midfacial degloving or craniofacial approaches.

Results: One patient who underwent excision by midfacial degloving approach had recurrence. This was removed by lateral rhinotomy approach. Two patients were subjected to radiotherapy due to the presence of mitotic figures on histopathology. All the patients are asymptomatic at 6 months follow-up.

Conclusions: Aggressive inverted papillomas may have varied presentation. They could have multiple recurrences, bilateral presentation or intracranial extension. They can be effectively managed with bilateral lateral rhinotomy or cranio-facial resection. Adjuvant radiotherapy has a role in controlling recurrences.