Outcomes of the Extended Endoscopic Approach for Management of Inverted Papilloma
Bibliographic record
Abstract
BACKGROUND: Inverted papilloma (IP) is a benign tumour involving the paranasal sinuses. Given its tendency to recurrence and potential for malignancy, complete removal of the papilloma remains the treatment of choice. Since 1994, we have routinely employed an extended endoscopic approach for the resection of inverted papillomas. We present our methods and outcomes. METHOD: The study was conducted in an academic tertiary care hospital-based practice. It is a retrospective review of patients treated by a single surgeon. IP was diagnosed by biopsy before surgery. With computed tomography and magnetic resonance imaging, we attempt to identify the sites of origin and extent of IP. Cases with previous medial maxillectomy or invasive disease are treated via the open approach. Otherwise, the extended endoscopic approach is used. The tumour is debulked, and its attachment points are identified. Endoscopic medial maxillectomy is then performed. If maxillary sinus involvement in its anterior, inferior, superior, or lateral portion is suspected, a Caldwell-Luc approach is performed to allow for mucosal excision and complete removal of the anterior lateral nasal wall. When the lamina papyracea or ceiling of the ethmoid or sphenoid sinus is involved, the bony wall is resected. The frontal recess can be approached via a Lynch incision or an endoscopic transorbital approach. RESULTS: Twenty-two patients were referred for IP. Nineteen patients were treated via the extended endoscopic approach. The average follow-up period was 23 (3-66) months. Only 3 of 19 patients (16%) presented with a recurrence or failure of initial surgery that required revision surgery. CONCLUSION: The extended endoscopic approach offers a safe, effective, and aesthetically acceptable treatment of most cases of IP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".