Key results
Our patient cohort demographics were
similar to other studies, with an
observed 2:1 male-to-female ratio and average age of presentation of
62.8 years. As in previous research, the maxillary sinus was the most
common site for primary IPs. (5) In literature, primary and secondary
cases have recurrence rates of 10% and 29% respectively (5,6), which
is comparable to our cohort’s recurrence rates of 15% (6/40) and 37.5%
(15/40) for our primary and secondary cases.
The mean time of recurrence was 20 and 39 months for primary and
secondary cases, which is different to what has been found in previous
literature. (5) This difference could be explained by the faster
detection rate and the significantly smaller number of recurrences in
primary cases seen in our cohort (16% vs 84%), highlighting that
outcomes and recurrence rates for IP are better when managed by a
fellowship-trained rhinologist.
As in previous literature, patients with Krouse stage 3 cases and IPs
located in the frontal and maxillary sinuses had the highest rates of
recurrences. (5,6) This may be explained by the technical difficulty of
accessing the frontal sinus, limited visualisation of the tumour via
endoscopy, and the challenge of obtaining a margin when up against
critical structures. (8) Similarly, maxillary IPs are associated with
increased recurrence rates in literature; (6) due to the challenging
visualisation and access of the site (2,6), especially the floor of the
antrum and medial maxillary wall.
The worse outcomes seen in secondary cases may be explained by the
absence of landmarks due to previous dissections, scarring and distorted
anatomy. (9) However, our cohort further highlights that IPs have a
lower rate of recurrences when managed by a fellowship-trained
rhinologist. Thus, figure 2 contains the suggested gold-standard
treatment pathway for all sinonasal tumours.