Date post: | 30-Jun-2015 |
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Health & Medicine |
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NASAL POLYP
• Non neoplastic masses of edematous nasal or sinus mucosa
TYPES • 2 Types bilateral ethmoidal polypi
antrochoanal polypi
Bilateral ethmoidal polyp
Aetiology
Chronic rhinosinusitis
Sampter’s triad
Cystic fibrosis
Allergic fungal sinusitis
kartagener’s syndrome
Young’s syndrome
Churg strauss syndrome
nasal mastocytosis
PATHOGENESISAetiology
Collection of extracellular fluid
Edema of nasal mucosa
PATHOLOGICAL CHANGES
Ciliated columnar epithelium (normal)
Atmospheric irritation
Metaplastic change to transitional and squamous type
• Sub mucosa- large intercellular space filled with serous fluid
• Infiltration with eosinophils and round cells
COMMON SITES
Uncinate
process
Bulla ethmoidalis
Ostia of
sinusMedial surface
and edge of middle turbinate
SYMPTOMSNasal stiffness—Nasal obstruction
Loss of smell
Head ache
Sneezing
Watery nasal discharge
Mass protruding from nostrils
SIGNSAnterior
rhinoscopy---smooth glistening grape like mass
Nasal cavity---purulent
discharge
Long standing cases---broadening of nose
and increased intercanthal distance
DIFFERENTIAL DIAGNOSIS
Hypertrophy of turbina
te
Cystic middle turbin
ate
TREATMENT
Medical treatmentAntihistaminics
Steroids
Surgical treatment
Polypectomy
Intranasal etmoidectomy
Extranasal etmoidectomy
Trasantral etmoidectomy
FESS
ANTROCHOANAL POLYPI
Antral
ChoanalNasal
AETIOLOGY• Common in children and young
adults• Nasal allergy +sinus infection-most
common cause• Usually single and unilateral
SYMPTOMS
Unilateral nasal
obstruction
Thick and dull
voice
Nasal dishar
ge
SIGNSanterior rhinoscopy
Large polyp-greyish mass+nasal
discharge
small polyp-
masked
Soft&can be
moved up&down with probe
Posterior rhinoscopy
Globular mass filling the
choana/oropharynx
Large polyp-hang ddown beneath soft
palate&present in oropharynx
DIFFERENTIAL DIAGNOSIS
A blob of mucus
Hypertrophied
middleturbinate
Angiofibroma
neoplasm
INVESTIGATIONS
• X-ray of paranasal sinuses• X-ray of softtissue nasopharynx
TREATMENT
Avulsion through nasal/oral route
Caldwell-luc operation
Endoscopic sinuss surgery