I have had five operations for nasal polyps. I convinced the doctor to do a biopsy and he found inverted papilloma. An ear, nose and throat specialist performed a turbinectomy, lateral rhinotomy and an ethmoidectomy. The next day I was diagnosed with post-operative cellulitis infection. One month later, I still have a swollen and frozen right nostril and significant pain on the right side of my nose. I cannot wear eyeglasses and thus cannot work. Could you give a short explanation of this operation and tell me what to expect in the future?

A.M.

Inverted papilloma is a nasal tumor that is often mistaken for common nasal polyps. The only way to tell the two apart is to examine a tissue sample under the microscope. It is important to do this whenever a polyp (or any tissue) is removed from the nose. Otherwise, the doctor can miss such diagnoses as inverted papilloma, cancer, unusual infections and so forth. It is inappropriate to assume, "Looks like a polyp, must be a polyp."

Inverted papilloma is a benign tumor. That means it does not have the ability to spread, or metastasize, to other parts of the body, as cancers do. It can only do damage by invading tissues within or next to the nose. It is a dangerous growth for two reasons. First, true cancers arise within approximately 10 percent to 15 percent of inverted papillomas. Second, inverted papillomas have a nasty tendency to recur in the same area if they are incompletely removed. For these two reasons, inverted papillomas must be cut out completely.

Medial maxillectomy is the usual operation to remove an inverted papilloma. In this operation, the side wall of the nasal cavity is removed. (The nasal cavity is what the nostrils lead into.) The side wall normally separates the nasal cavity from the maxillary sinus, which is a hollowed-out area within the cheekbone. One way to accomplish this operation is with a lateral rhinotomy, an incision along the border of the nose, curving beneath the nostril. The inferior turbinate is a bony, fleshy structure arising from the side wall of the nasal cavity. Removal of the turbinate (turbinectomy) is part of the medial maxillectomy operation. Finally, the ethmoid sinuses are located above the inferior turbinate and are frequently invaded by inverted papilloma. The operation to remove these sinuses is called an ethmoidectomy.

You had a pos-operative cellulitis, meaning that your tissues were inflamed from a bacterial infection. The lateral rhinotomy caused inflammation of the nostril, and the post-operative cellulitis made it worse. This accounts for your swollen, painful right nostril. "Frozen" suggests that you are not able to flare the right nostril. This occurs because the lateral rhinotomy incision cut across the muscles that are used to flare the nostril. Also, inflammation stiffens facial tissues, making them less mobile.

The inflammation will subside, but this may take several weeks or even months. Your ear, nose and throat specialist (ENT) needs to examine the wound to see if the inflammation is due to chronic infection. If it is not infected, then you can treat the swelling by sleeping with your head elevated above the level of your heart, massaging the swollen area, and waiting it out (a treatment called "tincture of time"). Anti-inflammatory drugs such as ibuprofen (Advil) may be helpful in controlling your pain in these early days following surgery. If the pain persists, you doctor may think it helpful to inject a local anesthetic combined with a long-acting steroid. You should discuss these treatment options with your ENT.

You state, "I cannot wear eyeglasses and thus cannot work." What about contact lenses? Contact lenses have come a long way in the last 20 years. Previously incorrectable problems, such as astigmatism, are correctable with modern soft lenses. Before you resign yourself to total disability, you ought to discuss the matter with your optometrist.