Nasal Polyps
Definition:
Polyps – Greek word – Polypous – many footed
- Oedematous,
hypertrophied, Pedunculated mucosa of Nose + Paranasal sinuses
Sites
1. Ethmoidal:
- Poor Blood Supply of Ethmoid Sinus
- 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:-
- Associated with asthama
- Allergic symptoms like Sneezing, rhinorrhea and itching
- aspirin Hypersensitivity
Age & Sex
- Any age group above 2 yrs
- Cystic fibrosis develops earlier (Befroe 10 yrs)
- Below 2 yrs – Meningocoele and Encephalocoele
- Sex : Equal – In our context (Male:female = 2:1)
Symptoms
- 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
- Translucent white bags of polyp
- Pinkish – Repeated Trauma, Infection
- Polyps may protrude out through the vestibule
Polyp may
• Flaring
of Alae of nose
• Polyps Hanging in oral cavity
Investigation
- X-ray
- PNS OM view – Mucosal Thickening / Opaque antrum – fluid level
- CT Scan – Nose and Para Nasal Sinuses
- - Both coronal and axial section (Osteomeatal complex)
TREATMENT
- 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
|
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