Transcript Document
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
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Hypertrophied inferior turbinate
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Blob of mucous
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Inverted papilloma
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Rhinosporiosis & rhinoscleroma
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Angiofibroma
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Meningocoele
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Malignancy
Nasal mass
Oropharynx examination
Oropharynx examination
Posterior rhinoscopy
Examination of nasal mass
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Inspection = side, size, number, color, surface, pedunculated or sessile, origin, attachment
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Probing = consistency, sensitivity to touch, bleeding on touch, can be passed all around
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Shrinkage with decongestant drops
Probe test Antrochoanal polyp Hypertrophied turbinate Insensitive to pain Sensitive Probe can be passed all around Mobile Cannot be passed Not mobile
Etiology & origin Etiology:
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Infective maxillary sinusitis
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Anomaly of maxillary sinus ostium Origin:
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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
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Diagnostic Nasal Endoscopy
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X-ray PNS (Waters view)
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X-ray nasopharynx lateral view: presence of air b/w skull base & polyp
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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
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Antibiotics (pre & post operatively)
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F.E.S.S. (avulsion polypectomy with middle meatal antrostomy)
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Caldwell – Luc operation (for recurrence)
How to prevent recurrence
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Complete removal of all parts
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Wide middle meatal antrostomy (widening of maxillary sinus ostium)
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Post-operative antibiotics
Parts of Killian’s A.C. polyp
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Antral: globular
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Nasal: flattened transversely
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Choanal: globular
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Neck: present at maxillary ostium
Middle meatal antrostomy
Caldwell – Luc Operation
Ethmoid Polyp
Clinical Presentation Adult patient
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Bilateral nasal obstruction
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Bilateral watery nasal discharge
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Excessive, paroxysmal sneezing
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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
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Diagnostic Nasal Endoscopy (D.N.E.)
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X-ray PNS (Rhese lateral oblique view)
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C.T. scan P.N.S. (coronal cuts)
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Tests for allergy
Diagnostic Nasal Endoscopy
Diagnostic Nasal Endoscopy
Diagnostic Nasal Endoscopy
CT scan Paranasal Sinus
Non-surgical Treatment Given for very small polyps
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Avoid allergens
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Oral antihistamines (1-3 months)
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Corticosteroid nasal sprays (3-6 months)
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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:
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Oral antihistamines (1-3 months)
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Corticosteroid nasal sprays (3-6 months)
Bilateral FESS cavities
Post FESS CT scan
Antrochoanal polyp
Seen in
a
dolescents &
c
hildren Etiology is infection
Ethmoid polyp
Adult Allergic Single Unilateral Multiple Bilateral Shape is tri-lobed (dumbbell) Grows backward Treatment is surgical Recurrence is uncommon Grape like Forward Medical + Surgical Common
Thank You