Inverted papilloma are the most common sinonasal tumors with a tendency for recurrence, extension to the orbit and skull base, and risk of malignant degeneration into squamous cell carcinoma While the overall rate of recurrence has decreased with the widespread adoption of high-definition endoscopic optics and advanced surgical tools, there remain challenges in managing tumors that involve vital neurovascular structures. Here we review the clinical features, diagnostic tools for these tumours, contemporary surgical management, and regular follow up.