Wednesday, January 14, 2015

Nasal Polyps
Definition:

Polyps – Greek word – Polypous – many footed
  - Oedematous, hypertrophied, Pedunculated mucosa of Nose + Paranasal sinuses
Sites
1. Ethmoidal:
  1.  Poor Blood Supply of Ethmoid Sinus
  2.  Complex anatomy of Ethmoid Labyrinth
2. Maxillary
     Rare – Sphenoidal and Frontal
    Site of origin – Middle meatus (All the sinus ostium opens)
Types of Nasal Polyps
1.     Antrochoanal Polyps (Killian’s Polyps)
2.     Ethmoidal Polyps (Nasal Polyps)
3.     Sphenoidal Polyps (Rare)
Etiological Factors
1. Infection:-
Recurrent Infection of PNS 
2. Allergy:-
  1. Associated with asthama
  2. Allergic symptoms like Sneezing, rhinorrhea  and itching
  3. aspirin Hypersensitivity

Age & Sex
  1. Any age group above 2 yrs
  2. Cystic fibrosis develops earlier (Befroe 10 yrs)
  3. Below 2 yrs – Meningocoele and Encephalocoele
  4. Sex : Equal – In our context (Male:female = 2:1)

Symptoms
  1. Nasal obstruction :
    Unilateral / Bilateral, Mild / Severe
2. Rhinorrhea and sneezing
3. Decrease sense of smell / complete loss
              Decrease sense of taste
4. Pain – Normally Painless
    Over bridge of Nose, forehead and cheek
5. Post Nasal Drip :
    White / Yellow (Severe Eosinophillia)
6. Epistaxis :
    Uncommon, Inverted Papilloma, Malignancy
7. Hypo Nasal Voice
8. Mouth Breathing
Signs
1. Anterior Rhinoscopy
  1.  Translucent white bags of polyp
  2.  Pinkish – Repeated Trauma, Infection
  3.  Polyps may protrude out through the vestibule
Polyp may
       Flaring of Alae of nose
        Polyps Hanging in oral cavity
Investigation
  1. X-ray
  2. PNS OM view – Mucosal Thickening / Opaque antrum – fluid level
  3. CT Scan – Nose and Para Nasal Sinuses
  4.      - Both coronal and axial section (Osteomeatal complex)
TREATMENT
  1. Medical Treatment
    Minimal Polyps, Extesive polyps – to reduce the size
    “Medical Ethmoidectomy”
Tab. Prednisolone  -  1mg /kg body wt.
Betamethasone Nose Drop – 2 drops bid for 2 weeks
Steroid spray – for 3 months
2. Surgical treatment
A.FESS
B. External Approach
       Ethmoid – External ethmoidectomy (Lynch Howarth)
                      Intra Nasal Ethmoidectomy
                      Horgans Approach
        AC polyp – Caldwel Luc Surgery
                          Intra Nasal Polypectomy
Complications of surgery
Bleeding
- Intra Operative
- Post Operative
-        Damage to Lamina Papyracea
- Black Eye / Subcutanious oedema in infra orbital area.
- Occ. CSF Rhinorrhea
- Late Complication – Synechiae formation
Differentiation between AC polyp and Ethmoidal Polyp
AC
Ethmoidal
Origin- Lateral Wall+ floor of Maxillary Antrum
Ethmoid Lybrinth
Single
Multiple
Goes posteriorly
Comes anteriorly
Etiology: Infection
Allergy
Recurrence: Uncommon
Common
Caldwel Luc Surgery
Ethmoidectomy









1 comment:

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