Nasal Polyps Dr. Vishal Sharma. Nasal Polyp Hypertrophied, oedematous, prolapsed mucosa of nose &...
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Transcript of Nasal Polyps Dr. Vishal Sharma. Nasal Polyp Hypertrophied, oedematous, prolapsed mucosa of nose &...
Nasal Polyps
Dr. Vishal Sharma
Nasal Polyp
Hypertrophied, oedematous, prolapsed mucosa
of nose & paranasal sinus.
Properties of nasal polyp:
Gray in colour Glistening Smooth surface
Pedunculated Insensitive to pain Mobile
Does not bleed on probing
Antro-choanal
Polyp
Clinical Presentation
Adolescent / child
Unilateral nasal obstruction
Unilateral nasal discharge
Differential diagnosis• Hypertrophied inferior turbinate
• Blob of mucous
• Inverted papilloma
• Rhinosporiosis & rhinoscleroma
• Angiofibroma
• Meningocoele
• Malignancy
Nasal mass
Oropharynx examination
Oropharynx examination
Posterior rhinoscopy
Examination of nasal mass
• Inspection = side, size, number, color, surface,
pedunculated or sessile, origin, attachment
• Probing = consistency, sensitivity to touch,
bleeding on touch, can be passed all around
• Shrinkage with decongestant drops
Probe testAntrochoanal polyp Hypertrophied turbinate
Insensitive to pain Sensitive
Probe can be passed all around
Cannot be passed
Mobile Not mobile
Etiology & origin
Etiology:
– Infective maxillary sinusitis
– Anomaly of maxillary sinus ostium
Origin:
• Arises from maxillary sinus mucosa & exits
via its natural or accessory ostium
Why AC polyp goes back?
1. Maxillary ostium is directed posteriorly
2. Cilia beat posteriorly
3. Air current flows posteriorly
4. Nasal floor slopes posteriorly
5. Posterior nasal cavity is larger
6. Negative oropharynx pressure while swallowing
Investigations
• Diagnostic Nasal Endoscopy
• X-ray PNS (Waters view)
• X-ray nasopharynx lateral view:
presence of air b/w skull base & polyp
• CT scan PNS (coronal cuts)
Diagnostic Nasal Endoscopy
Diagnostic Nasal Endoscopy
X-ray Paranasal Sinus
C.T. scan Paranasal Sinus
C.T. scan Paranasal Sinus
Treatment
• Antibiotics (pre & post operatively)
• F.E.S.S. (avulsion polypectomy with middle
meatal antrostomy)
• Caldwell – Luc operation (for recurrence)
How to prevent recurrence
• Complete removal of all parts
• Wide middle meatal antrostomy (widening of
maxillary sinus ostium)
• Post-operative antibiotics
Parts of Killian’s A.C. polyp
• Antral: globular
• Nasal: flattened
transversely
• Choanal: globular
• Neck: present at
maxillary ostium
Middle meatal antrostomy
Caldwell – Luc Operation
Ethmoid Polyp
Clinical Presentation
Adult patient
• Bilateral nasal obstruction
• Bilateral watery nasal discharge
• Excessive, paroxysmal sneezing
• H/o previous nasal surgery
B/l nasal mass
Anterior rhinoscopy
Broadening of nasal bridge
Etiology of ethmoid polyp
1. Allergy
2. Allergy + Infection
3. Vasomotor imbalance
4. Bernoulli phenomenon
5. Poly-saccharide changes
Associated diseases
1. Aspirin intolerance + Bronchial asthma +
Ethmoid polypi = Samter’s triad
2. Cystic fibrosis 3. Allergic fungal sinusitis
4. Kartagener’s syndrome (ciliary dyskinesia +
situs invertus)
5. Young’s syndrome (hyperviscous mucous +
azoospermia)
Investigations
• Diagnostic Nasal Endoscopy (D.N.E.)
• X-ray PNS (Rhese lateral oblique view)
• C.T. scan P.N.S. (coronal cuts)
• Tests for allergy
Diagnostic Nasal Endoscopy
Diagnostic Nasal Endoscopy
Diagnostic Nasal Endoscopy
CT scan Paranasal Sinus
Non-surgical Treatment
Given for very small polyps
• Avoid allergens
• Oral antihistamines (1-3 months)
• Corticosteroid nasal sprays (3-6 months)
• Oral prednisolone (1 mg/kg/day for 2 weeks)
Pre-steroid vs. Post-steroid
Surgical Treatment
1. Intra-nasal avulsion polypectomy
2. Extra-nasal external ethmoidectomy
3. Trans-antral ethmoidectomy
4. Functional Endoscopic Sinus Surgery
Conventional Micro-debrider Laser
F.E.S.S.
F.E.S.S. instruments
F.E.S.S. with navigation
Micro-debrider
Micro-debrider
How to prevent recurrence
1. Complete removal of all polyps
2. Avoid allergens
3. Post-operative course of:
• Oral antihistamines (1-3 months)
• Corticosteroid nasal sprays (3-6 months)
Bilateral FESS cavities
Post FESS CT scan
Antrochoanal polyp Ethmoid polyp
Seen in adolescents & children Adult
Etiology is infection Allergic
Single Multiple
Unilateral Bilateral
Shape is tri-lobed (dumbbell) Grape like
Grows backward Forward
Treatment is surgical Medical + Surgical
Recurrence is uncommon Common
Thank You