Schneiderian Papilloma - An Overview

Introduction:

The Schneiderian papillomas are also known as sinonasal, transitional, and Ringertz tumors. The cells undergo local invasion of surrounding tissues, also called inverted papillomas. It is a condition that is more frequent among long-standing rhinitis patients. The recurrence rate post-surgically is very high in these cases. They are locally aggressive. It can progress into neoplastic or cancerous tumors.

What Is Schneiderian Papilloma and How Is It Caused?

Sinonasal papillomas or Schneiderian papillomas are rare benign tumors occurring in less than a percent of one lakh population. It is seen during the fifth and sixth decades of life. The growth is seen bilaterally and in multifocal areas. Schneiderian papillomas are caused due to viral infections and other foreign particles like pollutants and toxins.

Where Is a Schneiderian Membrane Located?

The Schneiderian epithelium is a lining membrane seen on the surface of the nasal cavity and paranasal region. The epithelial layer comprises ciliated columnar cells and goblet cells. During surgical procedures like sinus grafting, this membrane is more prone to trauma leading to its tear. So at the time when the graft is placed, the sinus tissue of the Schneiderian membrane is also repaired. However, infection of this epithelial membrane post-surgery can lead to treatment failure. The infection may result from a failed bone graft or a dental implant. The infection approaches the maxillary sinus and the adjacent structures.

What Are the Symptoms Associated With Schneiderian Papilloma?

Some of the symptoms exhibited are:

• Headache.

• Swelling of the face.

• Anosmia (loss of sense of smell).

• Abnormal growth in the nasal cavity.

• Change in voice or hoarseness of voice.

• Chronic cough.

• Shortness of breath.

• Noisy breath.

• Large papillomas block airway passage.

• Pneumonia.

• Failure to thrive.

• Respiratory fatigue.

• Double vision and droopy eyelids.

• Pain in the hands.

What Are the Different Types of Schneiderian Papillomas Present?

The Schneiderian papillomas are present in three different kinds. They are:

• Exophytic Papillomas or Fungiform Papillomas: It is also known as septal papillomas. Both septal and inverted papillomas are common in occurrence. Both exophytic and inverted papillomas are caused due to human papillomavirus (HPV).

• Inverted Papilloma: These show inverted growth patterns with squamous epithelial cells down and chronic inflammatory cells upside. They are the commonest forms to occur. Half of the population is affected by inverted lesions. They occur in children as well. Around ten percent of the population shows malignancies.

• Oncocytic Papilloma or Cylindrical Papilloma: The oncocytic papillomas are not caused due to human papillomavirus (HPV) infection. They are very rare in occurrence and constitute about two percent of the overall population.

What Is the Epidemiology of Schneiderian Papilloma?

• The annual incidence ranges from 0.74 to 2.3 per 100,000 people.

• The most common kind is inverted papilloma, followed by exophytic papilloma; oncocytic papilloma is the least common.

• Inverted and oncocytic papillomas most usually affect people in their fifth to sixth decades, whereas exophytic papilloma affects patients in their third to fifth decades.

• Males are more likely to develop inverted and exophytic papillomas; oncocytic papilloma impacts men and women equally.

What Is Laryngeal Papillomatosis?

Laryngeal papillomatosis is a rare condition with wart-like growth or papillomas occurring in the larynx region. These growths are benign in nature and primarily invade the vocal cord and glottis tissue. These lesions can travel down the throat into the lung spaces from the vocal cords. Due to its high recurrence rate, it is also known as recurrent respiratory papillomatosis. Among all populations, the severe form of the disease is observed among juveniles. In children, it occurs around five years of age, and in adults from 30 to 40 years. It is rarely manifested in older people above 60 years. They are caused by type 6 and 11 human papillomaviruses (HPV). In children, this can be inherited directly from the mother's blood to the child. The risk factor associated with juvenile papilloma is the high incidence rate among firstborn children, those having a vaginal delivery, and mothers delivering under the age of 20. The mode of transmission in adults is still unknown. Certain factors like oral sex and multiple sexual partners have a high potential threat to spread the infection.

How to Diagnose Schneiderian Papillomas?

Various tests are present to diagnose the condition, such as:

• Local Examination: The physician examines the growth using a flexible fibro-optic laryngeal endoscopy into the deep pharynx to determine the tumor's site and size. A flexible scope called a fiberscope is placed inside the throat through the nose. This helps in visualizing the larynx in a much clearer way.

• Biopsy: A tissue sample can be collected using fine needle aspiration to confirm the diagnosis. This can also be done to check for human papillomavirus (HPV).

• Computed Tomography (CT): A diagnostic imaging of the head and neck region will give a definite image of the spread of the lesion.

Is Schneiderian Papilloma Curable?

Various treatment modalities are present to cure the disease, such as:

• Surgery: This includes completely removing papillomas and reducing the chances of recurrence by leaving zero negative tissue behind. In children, repeated treatment is required due to high rates of recurrence. The surgical procedure may include carbon dioxide laser surgery and microdebrider. Microdebrider surgery is faster and economically feasible. The patient gets a better-restored voice quality with microdebrider surgery.

• Voice Therapy: Proper voice therapy should be maintained in order to improve voice function.

• Medical Management: Surgery alone cannot cure the condition. Proper medical treatment is recommended by giving supplements of antiviral drugs like Cidofovir, Interferon, and photodynamic therapy in patients.

• Radiation Therapy: If the lesion is malignant, then a high dose of radiation is invoked at the site of the lesion to kill the papillomas.

The prognosis of Schneiderian papilloma depends on the success of the surgery. If the lesion is completely removed, then the prognosis is good. Since the lesions are high in recurrence, the patient is advised for a proper follow-up every five years.

Conclusion:

Papillomas of the respiratory tract are benign lesions and recurrent. These little frowns of tissues can affect the vocal cords of the larynx. They are mostly associated with human papillomavirus. The laser treatment has proven successful in targeting those lesions from recurring. The chances of remission are high even after a few years of post-treatment.