Sinonasal Inverted Papilloma: Demographics, Recurrence Predictors, and Surgical Outcomes — A 10-Year Retrospective Review at a Tertiary Center in Saudi Arabia

Objectives: To characterize the demographic, clinical, and radiological profile of patients with sinonasal inverted papilloma (IP) managed at a tertiary center in Saudi Arabia, to determine recurrence rates in primary versus revision cases, and to identify factors associated with recurrence.Methods: This retrospective observational study included 59 adult patients with histopathologically confirmed sinonasal inverted papilloma (IP). Demographic, clinical, radiological, and surgical data were extracted from medical records. Tumors were staged using the Krouse system. Patients were stratified into primary or revision cases, and associations with recurrence were evaluated.Results: Most patients were men (72.9%) and older than 45 (79.7%) years old. All tumors were unilateral, most frequently arising from the maxillary sinus (40.7%) or lateral nasal wall (39%); most were Krouse T2 (45.8%). Hyperostosis was present in 52.5% of cases. Recurrence occurred in 23 patients (39%): 16.7% in primary cases (6/36) and 73.9% in revision cases (17/23). All 4 combined endoscopic-external cases recurred, versus 34.5% treated endoscopically. Smoking, Krouse stage, anatomical site, hyperostosis, allergic rhinitis, and malignant transformation were not associated with recurrence.Conclusion: In this Saudi Arabian cohort, revision status was the dominant correlate of sinonasal IP recurrence, and the surgical approach reflected disease complexity. These findings support stratified postoperative surveillance and attachment-oriented surgical planning, particularly for revision surgery. Outcomes in primary cases were comparable to those reported in a contemporary endoscopic series.