Objective To evaluate the impacts of endoscopically assisted anterior lacrimal recess technique versus Caldwell-Luc approach on sinus function and 1-year recurrence rate of patients with inverted papilloma of nasal cavity and paranasal sinuses. Methods A total of 86 patients with inverted papilloma of nasal cavity and paranasal sinuses admitted from January 2019 to August 2022 were randomly divided into an observation group and a control group according to random number method, with 43 cases in each group. The observation group received treatment via the endoscopically assisted approach targeting the anterior lacrimal recess, while the control group was treated with endoscopically assisted Caldwell-Luc approach. The sinus function scores, surgery-related indicators,objective inspection indexes, and 1-year recurrence rate were compared between the two groups. Results Six months post-operation, the observation group showed significant improvements in nasal symptoms, sleep disturbances, emotional well-being, and symptom scores, surpassing those in the control group （P<0.05）. Surgical duration, blood loss during surgery, and lengths of hospital stays were also notably reduced in the observation group compared to the control group （P<0.05）. The scores of objective evaluations of conditions such as polyps, mucosal swelling, and nasal discharge in the observation group were significantly lower than those in the control group （P<0.05）. Furthermore, the rates of complications like nasolacrimal duct damage, channel adhesion, numbness around the wound, and narrowing of the wound were significantly lower in the observation group than in the control group （P<0.05）. Although the 1-year recurrence rate in the observation group was lower than that in the control group, this difference did not reach statistical significance （P>0.05）. Conclusion Endoscopy-assisted anterior lacrimal recess approach for the treatment of inverted papilloma of nasal cavity and paranasal sinuses has more significant advantages in improving sinus function, and reducing operation-related indicators, objective examination indicators and complications than the Caldwell-Luc approach. However, there is no significant difference between the two approaches in terms of recurrence rate one year after surgery.