Inverted Papilloma of the Temporal Bone: A Multicenter Case Series

• Main Authors: Modest, Mara C., Carlson, Matthew L., Janus, Jeffrey R., Sweeney, Alex D., Van Gompel, Jamie J., Haynes, David S., Neff, Brian A.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0035-1546506

Background and Objective: Inverted papillomas (IPs) are benign, locally invasive tumors that are most commonly present within the sinonasal cavity. Temporal bone involvement is exceedingly rare, with less than 30 cases that have been reported within the English literature to date. Temporal bone IP may occur primarily, or result from contiguous spread through the eustachian tube or infratemporal fossa. Herein, we report our experience managing three secondary temporal bone IPs. Details regarding clinical presentation, clinical course, and outcome are reviewed. Material and Methods: Three patients presented with temporal bone disease, who had a history of sinonasal IP. Results: All three patients were middle-aged males (P1,58years; P2,64years;and P3,53years) with a history of biopsy-proven IP of the sinonasal cavity and previous resection, now presenting with hearing loss and otorrhea (P1 and P2) or aural fullness and tinnitus (P3). P1 and P2 both had histories of chronic rhinosinusitis. Preoperative work-up for patients included a tissue biopsy (P1 and P2), audiogram (P1 to P3), CT (P1 to P3), and MRI (P1 P3). P1 and P2 both had imaging indicating intracranial and orbital extension in addition to temporal bone involvement. For P1, to reduce the risk of a spinal fluid leak, a staged resection was planned with initial removal of the intracranial and temporal disease, followed by a separate procedure for the sinonasal and orbital portions. The P2's tumor was initially diagnosed with sinonasal disease and underwent gross total resection via a transnasal endoscopic approach. Five months following resection, the patient presented with temporal bone disease demonstrating high-grade dysplasia. Surgical management subsequently included an intact canal wall mastoidectomy with ossicular chain reconstruction. P3 had signs indicative of a glomus tympanicum tumor on imaging, but intraoperative pathology revealed the mass to be an IP without malignant transformation. Gross total resection of the IP was accomplished via a transcanal approach, but required careful removal from the ossicles and dehiscent facial nerve. P1 has yet to undergo resection. P2 has had no signs of recurrence of the temporal IP but required resection of a sinonasal recurrence on two subsequent occasions. P3 has had no recurrence and both P2 and P3 are currently alive without evidence of disease (follow-up P2,16months and P3, 61months). Conclusion: IPs of the temporal bone are exceedingly rare, with l