Nasal Polyps Dr Vishal Sharma Nasal Polyp Hypertrophied

Nasal Polyp Hypertrophied, oedematous, prolapsed mucosa of nose & paranasal sinus. Properties of nasal

Clinical Presentation Adolescent / child Unilateral nasal obstruction Unilateral nasal discharge

Differential diagnosis • Hypertrophied inferior turbinate • Blob of mucous • Inverted papilloma •

Examination of nasal mass • Inspection = side, size, number, color, surface, pedunculated or

Probe test Antrochoanal polyp Hypertrophied turbinate Insensitive to pain Sensitive Probe can be passed

Etiology & origin Etiology: – Infective maxillary sinusitis – Anomaly of maxillary sinus ostium

Why AC polyp goes back? 1. Maxillary ostium is directed posteriorly 2. Cilia beat

Investigations • Diagnostic Nasal Endoscopy • X-ray PNS (Waters view) • X-ray nasopharynx lateral

Treatment • Antibiotics (pre & post operatively) • F. E. S. S. (avulsion polypectomy

How to prevent recurrence • Complete removal of all parts • Wide middle meatal

Parts of Killian’s A. C. polyp • Antral: globular • Nasal: flattened transversely •

Clinical Presentation Adult patient • Bilateral nasal obstruction • Bilateral watery nasal discharge •

Etiology of ethmoid polyp 1. Allergy 2. Allergy + Infection 3. Vasomotor imbalance 4.

Associated diseases 1. Aspirin intolerance + Bronchial asthma + Ethmoid polypi = Samter’s triad

Investigations • Diagnostic Nasal Endoscopy (D. N. E. ) • X-ray PNS (Rhese lateral

Non-surgical Treatment Given for very small polyps • Avoid allergens • Oral antihistamines (1

Surgical Treatment 1. Intra-nasal avulsion polypectomy 2. Extra-nasal external ethmoidectomy 3. Trans-antral ethmoidectomy 4.

How to prevent recurrence 1. Complete removal of all polyps 2. Avoid allergens 3.

Antrochoanal polyp Ethmoid polyp Seen in adolescents & children Adult Etiology is infection Allergic

Slides: 49

Download presentation

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

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 test Antrochoanal 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

X-ray 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

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

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