Medical history can end the clinical mystery: A case report of Inverted Sinonasal Papilloma with intra-oral involvement.

Aims/Objectives:
Inverted Sinonasal Papillomas (IP) are the most common benign neoplasm of the nasal cavity. They are locally aggressive, with an inward growth pattern, and can cause bony destruction. There is approximately 9% risk of malignant transformation, with squamous cell carcinoma being the most frequent tumour derived from IP. In this case study, we explore the presentation, diagnosis and complexities of management of an IP which eroded the maxillary sinus, and highlight the possible misleading intra-oral presentation dentists may be faced with.

Methods:
In this case study, a 70 year old male known smoker was referred to Ear, Nose & Throat (ENT) by his general medical practitioner for chronic rhino-sinusitis; and simultaneously was referred to the Oral Medicine clinic, within the OMFS unit, by his dentist, for concerns about a non-healing tissue mass adjacent to UR6. The dentist described the clinical appearance of granulation tissue and provisional diagnosis of Fibroepithelial Polyp.
Plain imaging was obtained and biopsy at the site was completed. Histopathology demonstrated an IP. Further imaging was arranged and a multidisciplinary approach with ENT adopted.

Results:
Endoscopic de-bulking and removal of the IP from the nasal cavity and maxillary sinus was completed by ENT, OMFS explored via Caldwell Luc approach which demonstrated extension of the neoplasm to the anterior maxillary sinus where further debridement was completed. Access was closed with a buccal advancement flap and an obturator was fitted.

Conclusions:
This case outlines the presentation, diagnosis and management of a patient with an IP; highlighting the potentially misleading oral presentation of maxillary tumours.
The most significant learning points from this case are for clinicians to have a high index of suspicion for chronic intra-oral masses, and the importance of taking a thorough and comprehensive medical history to assist with diagnoses.

References:
Nygren A. Rate of recurrence and malignant transformation in 88 cases with IP 1998–2008. PMID: 26838581.