Abstract: Objective To investigate the effect of low-temperature plasma therapy on the treatment of inverted papilloma of the maxillary sinus and the influencing factors of recurrence. 
Methods A total of 331 patients with inverted papilloma of the maxillary sinus were selected and underwent low-temperature plasma surgery. The surgical effects and recurrence were statistically analyzed. The clinical data of the recurrence group (n=48) and non-recurrence group (n=273) were compared, and the factors affecting recurrence were analyzed using multivariate analysis. The Logistic regression model was evaluated for its predictive value for recurrence, and individual values were verified. 
Results The total effective rate of 331 patients with inverted papilloma of the maxillary sinus undergoing low-temperature plasma surgery was 85.80% (284/331), the total complication rate was 4.83% (16/331), and the recurrence rate was 14.95% (48/321). The levels of vascular endothelial growth factor (VEGF), human papillomavirus infection, Krouse classification, degree of atypical hyperplasia, history of nasal surgery, and number of mitotic figures in the recurrence group were higher than those in the non-recurrence group, and the difference were statistically significant (P＜0.05). The results of Logistic multivariate analysis showed that increased VEGF levels (OR=9.167, 95%CI: 4.456-18.857), Krouse grade Ⅲ (OR=7.280, 95%CI: 2.267-23.381), obvious atypical hyperplasia (OR=10.608, 95%CI: 5.611-20.054), and mitotic figures ＞10 (OR=8.121, 95%CI: 3.762-17.531) were independent risk factors for recurrence in patients with inverted papilloma of the maxillary sinus after surgery (P＜0.05). The Logistic regression model analysis of the predictive value for recurrence showed that the optimal critical value was 4.30, with an AUC of 0.919 and a 95%CI of 0.884-0.947. Verification by individual patients showed that under the condition of an accuracy rate of 89.72%, the patient had no risk of recurrence and was in line with clinical reality. 
Conclusion The application of low-temperature plasma surgery in the treatment of inverted papilloma of the maxillary sinus has significant efficacy, but its postoperative recurrence is affected by multiple factors, such as VEGF levels, Krouse classification, atypical hyperplasia, and mitotic figures. A comprehensive consideration of these factors and active intervention are beneficial to prevent recurrence. 

Key words: maxillary sinus neoplasms, cryoelectron microscopy, recurrence