Inverted papilloma of the nose and paranasal sinuses is an unusual benign neoplasm that has the propensity for local tissue destruction and an association with malignant degeneration. The tumor represents an inverted growth of epithelium rather than outward proliferation. It most commonly arises from the lateral nasal wall with growth into the nose and paranasal sinuses and only rarely originates from the septum. Presenting symptoms are usually unilateral nasal obstruction and clear rhinorrhea. Surgical excision is the recommended treatment though the aggressiveness of the approach has varied. Transnasal local excision has been associated with a high recurrence rate. Lateral rhinotomy with removal of the lateral nasal wall and wide local excision has a low recurrence rate and has been the recommended treatment by most authors since 1980. However, the poor cosmetic results in some patients due to the visible external scar is especially undesirable in young females. We present a series of 23 patients treated over a ten-year period. Fifteen underwent a Denker rhinotomy and medial maxillectomy through a sublabial approach without an external incision. The recurrence rate in our group is 27% with a mean 4.7 year follow-up. This recurrence rate lies between that reported for lateral rhinotomy and local transnasal excision.