Management of Inverted Papilloma of the Temporal Bone

Objective: The purposes of this study are to (1) understand the clinical presentation, etiology, and histopathology of inverting papilloma of the temporal bone; and (2) discuss current treatment and management of inverting papilloma of the temporal bone as well as considerations for future management.

Methods: Inverted papilloma (IP), a benign neoplasm typically arising within the sinonasal tract, has rarely been reported to occur outside the sinonasal tract. Only 17 cases of temporal bone IP have been reported. We review our two cases of temporal bone IP and discuss their management.

Results: Our first case was a patient with a history of sinonasal IP who had undergone three previous endoscopic resections when she presented with a subepithelial mass extending from the posterior wall of the ear canal. She was found to have extensive bony destruction and underwent a retrolabyrinthine approach with tympanomastoid obliteration. Recurrence was monitored with baseline and follow-up PET-CT scans. The second case was a primary lesion with an atypical otoscopic appearance of a granular mass extending from the middle ear through a tympanic membrane perforation. This was managed with a tympanomastoidectomy and clinically followed for recurrence.

Conclusion: Temporal bone IP is a rare neoplasm with no definitive treatment algorithm. We recommend aggressive surgical resection with close postoperative follow-up. PET-CT may be useful for identifying multicentric disease at presentation or for early identification of recurrent disease. HPV detection may identify IPs at risk for multicentric or recurrent disease.