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Nasal Polyps

Nasal Polyps

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Nasal Polyps

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  1. Nasal Polyps Dr. Vishal Sharma

  2. 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

  3. Antro-choanal Polyp

  4. Clinical Presentation  Adolescent / child  Unilateral nasal obstruction  Unilateral nasal discharge

  5. Differential diagnosis • Hypertrophied inferior turbinate • Blob of mucous • Inverted papilloma • Rhinosporiosis & rhinoscleroma • Angiofibroma • Meningocoele • Malignancy

  6. Nasal mass

  7. Oropharynx examination

  8. Oropharynx examination

  9. Posterior rhinoscopy

  10. 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

  11. Probe test

  12. Etiology & origin Etiology: • Infective maxillary sinusitis • Anomaly of maxillary sinus ostium Origin: • Arises from maxillary sinus mucosa & exits via its natural or accessory ostium

  13. 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

  14. 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)

  15. Diagnostic Nasal Endoscopy

  16. Diagnostic Nasal Endoscopy

  17. X-ray Paranasal Sinus

  18. C.T. scan Paranasal Sinus

  19. C.T. scan Paranasal Sinus

  20. Treatment • Antibiotics (pre & post operatively) • F.E.S.S. (avulsion polypectomy with middle meatal antrostomy) • Caldwell – Luc operation (for recurrence)

  21. How to prevent recurrence • Complete removal of all parts • Wide middle meatal antrostomy (widening of maxillary sinus ostium) • Post-operative antibiotics

  22. Parts of Killian’s A.C. polyp • Antral: globular • Nasal: flattened transversely • Choanal: globular • Neck: present at maxillary ostium

  23. Middle meatal antrostomy

  24. Caldwell – Luc Operation

  25. Ethmoid Polyp

  26. Clinical Presentation Adult patient • Bilateral nasal obstruction • Bilateral watery nasal discharge • Excessive, paroxysmal sneezing • H/o previous nasal surgery

  27. B/l nasal mass

  28. Anterior rhinoscopy

  29. Broadening of nasal bridge

  30. Etiology of ethmoid polyp 1. Allergy 2. Allergy + Infection 3. Vasomotor imbalance 4. Bernoulli phenomenon 5. Poly-saccharide changes

  31. 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)

  32. 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

  33. Diagnostic Nasal Endoscopy

  34. Diagnostic Nasal Endoscopy

  35. Diagnostic Nasal Endoscopy

  36. CT scan Paranasal Sinus

  37. 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)

  38. Pre-steroid vs. Post-steroid

  39. Surgical Treatment • Intra-nasal avulsion polypectomy • Extra-nasal external ethmoidectomy • Trans-antral ethmoidectomy • Functional Endoscopic Sinus Surgery  Conventional  Micro-debrider  Laser

  40. F.E.S.S.

  41. F.E.S.S. instruments

  42. F.E.S.S. with navigation

  43. Micro-debrider

  44. Micro-debrider

  45. 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)

  46. Bilateral FESS cavities

  47. Post FESS CT scan

  48. Thank You