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Nasal polyps
- 1. Nasal Polyps Dr. KrishnaKoirala
- 2. Definition • Nasal Polyp –Hypertrophied, edematous, pedunculated mucosa prolapsing out of the nose or paranasal sinus • Simple nasal polyps – Antrochoanal Polyp – Ethmoidal polyps
- 3. • Properties ofNasal Polyps – Pale /gray in color – Glistening – Smooth surface – Pedunculated – Insensitive to touch – Mobile – Does not bleed on probing
- 4. Antro - choanalPolyp ( Killian’s Polyp)
- 5. Etiology and origin •Etiology: – Infection – Proetz Theory (anomaly of maxillary sinus ostium) – Bernoulli’s phenomenon ( pressure drop next to constriction) • Origin: – Arises from maxillary sinus mucosa and exits via its natural or accessory ostium and extends to choana
- 6. Why does ACpolyp prefer to extend towards the choana? 1. Maxillary ostium is directed posteriorly 2. Cilia beat posteriorly 3. Air current flows posteriorly in a greater force 4. Nasal floor slopes posteriorly 5. Posterior nasal cavity is larger 6. Negative oropharyngeal pressure while swallowing
- 7. Parts of Killian’sAntrochoanal polyp • Antral: globular • Choanal: globular • Nasal: flattened transversely • Neck : present at maxillary ostium
- 8. Clinical presentation • Commonin children and adolescent age • Unilateral nasal obstruction • Unilateral nasal discharge • Occasionally nasal mass
- 9. Mass hanging inOropharynxUnilateral nasal mass
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- 11. Examination of nasalmass • 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
- 12. Probe test Antrochoanal polypHypertrophied turbinate Insensitive to pain Sensitive Probe can be passed all around Cannot be passed Mobile Not mobile
- 13. Differential Diagnosis • Hypertrophiedinferior turbinate • Blob of mucous • Inverted papilloma • Rhinosporidiosis / rhinoscleroma • Angiofibroma • Meningocoele • Malignancy
- 14. Investigations • Diagnostic NasalEndoscopy • X-ray PNS (Waters view) • X-ray nasopharynx lateral view: presence of air b/w skull base & polyp • CT scan PNS (coronal cuts)
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- 17. C.T. scan ParanasalSinus
- 18. Treatment • Antibiotics (pre& post operatively) • Avulsion polypectomy with middle meatal antrostomy • F.E.S.S. • Caldwell – Luc operation (for recurrence)
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- 20. Caldwell – LucOperation
- 21. How to preventrecurrence ? • Complete removal of all parts ( Nasal , Antral , Choanal) • Wide middle meatal antrostomy (widening of maxillary sinus ostium) • Post-operative antibiotics
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- 23. Clinical Presentation Adult patient •Bilateral nasal obstruction • Bilateral watery nasal discharge • Excessive, paroxysmal sneezing • H/o previous nasal surgery
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- 26. Broadening of nasalbridge
- 27. Etiology of ethmoidpolyp 1. Allergy 2. Allergy + Infection 3. Vasomotor imbalance 4. Bernoulli phenomenon 5. Poly-saccharide changes
- 28. Associated diseases 1. Aspirinintolerance + Bronchial asthma + Ethmoid polyps 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)
- 29. Investigations • Diagnostic NasalEndoscopy (D.N.E.) • X-ray PNS (Rhese lateral oblique view) • C.T. scan P.N.S. (coronal cuts) • Tests for allergy
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- 31. CT Scan ParanasalSinus
- 32. Non-surgical Treatment Given forvery small polyps • Avoid allergens • Oral antihistamines (1-3 months) • Corticosteroid nasal sprays (3-6 months) • Oral prednisolone (1 mg/kg/day for 2 weeks )
- 33. Pre - steroidvs. Post- steroid
- 34. Surgical Treatment 1. Intra-nasalavulsion polypectomy 2. Extra-nasal external ethmoidectomy 3. Trans-antral ethmoidectomy 4. Functional Endoscopic Sinus Surgery Conventional Micro - debrider Laser
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- 39. How to preventrecurrence? 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)
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- 41. Post FESS CTscan
- 42. Antrochoanal polyp Ethmoidpolyps Seen in adolescents & children Adult Etiology is infection Allergic Single Multiple Unilateral Bilateral Shape is tri-lobed (dumb-bell) Grape like Grows backward Forward Treatment is surgical Medical + Surgical Recurrence is uncommon Common