Nasal Polyp

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NASAL POLYP| neoplastic masses of oedematous nasal/ sinus mucosa

TYPES BILATERAL ETHMOIDAL


AETIOLOGY & PATHOGENESIS Arise in inflammatory conditions of mucosa (rhinitis) Disorder of ciliary motility (cystic fibrosis) Abnormal composition of nasal mucus Disease a/w polyp: o Chronic rhinosinusitis o 7% asthma o 36% aspirin intolerance

ANTROCHOANAL
AETIOLOGY & PATHOGENESIS arise from mucosa of ma"illary antrum near its accessory ostium #rows in choanan ! nasal ca$ity& 3 parts: o Antral: thin stal' o Choanal: round ! #lobular o (asal: flat from side to side C" is un'nown (asal aller#y ) sinus inf"*usually in children/ teena#ers +in#le ! unilateral SYMPTOMPS & SIGNS 0nilateral nose bloc' ay be bilateral (polyp #rowth in nasopharyn" ! obstructin# the opposite choana& 2hic' ! dull $oice d/t hyponasality (asal dischar#e (mucoid) 4row posteriorly .f lar#e 5 smooth #reyish mass co$ered w nasal dischar#e +oft ! mo$e up ! down w probe ay protrude out of nostril ! appear pin' con#ested on its e"posed sides 7osterior rhinoscopy shows: a& 4lobular mass fillin# choana ! nasopharyn" b& 7olyp may han# down behind soft palate ! present in oropharyn" TREATMENT :emo$ed by a$ulsion throu#h nasal/ oral route& :ecurrence ab( after complete remo$al

iddle meatus ! turbinate becomes oedematous d/t e"tracellular fluid collection polypoidal chan#e (sessile pedunculated) d/t #ra$ity ! e"cessi$e snee%in# PATHOLOGY ,pithelium uner#oes a metaplastic chan#e (from ciliated columnar transitional ! s-uamous type) d/t e"posure to atmospheric irritation .ntercellular spaces filled w serous fluid .nfiltration of eosinophils ! round cells&

/& 1& 3& 3& /& 1& 3& 3& 6&

SYMPTOMPS & SIGNS Anterior rhinoscopy show /& ultiple (any a#e but mainly adult) 1& (asal stuffiness nasal obstruction 3& 7artial/ total loss of smell 3& 8eadache a/w sinusitis 6& +nee%in#/ watery nasal dischar#e a/w aller#y 6& ass protrudin# from nostril /& 1& 3& 3& 6& 6& 7& Appear smooth9 #listerin#9 #rape li'e mass ! pale in color +essile/ pedunculated .nsensiti$e to probin# Do not bleed on touch ultiple ! bilateral 7rolon#ed 5 broadenin# of nose ! increase intracanthal distance& Apperar pin' d/t $ascular stimulatin# (if protrudin#)

;&

7urulent dischar#e d/t associated sinusitis DIAGNOSIS D" by clinical e"am C2 scan of paranasal sinuses : to e"clude bony erosion/ e"pansion su##estice of neoplasia aybe a/w mali#nancy esp& < 3= yo

IMPORTANT 7olyp is red ! fleshy9 friable9 has #ranular surface in older pt > mali#nancy +imple nasal polyps may mas' mali#nancy& 2hus A?? polyp should be sub@ected to 87, ,pista"is ! orbital symptoms a/w polyp should arouse suspicion of mali#nancy

TREATMENT !" CONSER#ATI#E Antihistamine ! aller#ic control (early chan#es mi#ht re$ert to normal) A short course of steroids (for ppl who canAt tolerate antihistamine/ asthma/ pre$ent recurrence after sur#ery) C/. for steroids: 82(9 70D9 D 92B9 7re#nant $" S%RGICAL 7olypectomy .ntranasal ethmoidectomy ,"tranasal ethmoidectomy (polyp recur after ., procedure/ sur#ical landmar's are ill 5 defined) 2ransantral etmoidectomy (when inf" ! polypoidal chan#e seen in the ma"illary antrum) ,ndoscopic sinus sur#ery (most preferred9 called C,++ DCunctional endoscopic sinus sur#eryE

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