Nasal Polyps

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

49. Thank You