Surgical and prognostic relevance of supraorbital ethmoid cell involvement in frontal sinus inverted papilloma.

Abstract

Background: The supraorbital ethmoid cell (SOEC) is a pneumatized extension of the anterior ethmoid sinus that may harbor residual disease after surgery, making complete surgical clearance challenging.

Objectives: To evaluate the surgical and prognostic relevance of SOEC involvement in frontal sinus (FS) inverted papilloma (IP), particularly its association with revision surgery and recurrence.

Methods: Data from 147 IP patients, including 32 with FS involvement, were retrospectively reviewed to identify true FS origin, FS extension, and SOEC involvement based on operative records and CT scans.

Results: True FS mucosal origin was identified in 2 patients (6.25%), while SOEC involvement was observed in 8 (25%), all of whom had prior surgeries. Among the 19 patients with previous surgeries, 8 (42.1%) had SOEC involvement, compared to none of the 13 without (p = 0.007). Patients with SOEC involvement underwent significantly more surgeries (median: 2 vs. 1; p = 0.041). True FS origin rates did not differ significantly (p = 0.345). After a median follow-up of 40.5 months, recurrence was not observed in patients with SOEC involvement (0/8), compared to 6 recurrences among those without (6/24; p = 0.149).

Conclusions and significance: SOEC involvement was more common in revision cases and linked to multiple prior surgeries, highlighting its importance in surgical planning and follow-up.