Presentation is loading. Please wait.

Presentation is loading. Please wait.

Nasal Polyps Dr. Vishal Sharma. Nasal Polyp Hypertrophied, oedematous, prolapsed mucosa of nose & paranasal sinus. Properties of nasal polyp: Gray in.

Similar presentations


Presentation on theme: "Nasal Polyps Dr. Vishal Sharma. Nasal Polyp Hypertrophied, oedematous, prolapsed mucosa of nose & paranasal sinus. Properties of nasal polyp: Gray in."— Presentation transcript:

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

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 Antrochoanal polypHypertrophied turbinate Insensitive to painSensitive Probe can be passed all around Cannot be passed MobileNot mobile

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

17 X-ray Paranasal Sinus

18 C.T. scan Paranasal Sinus

19

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 Killians 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 = Samters triad 2. Cystic fibrosis 3. Allergic fungal sinusitis 4. Kartageners syndrome (ciliary dyskinesia + situs invertus) 5. Youngs 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

35

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 1.Intra-nasal avulsion polypectomy 2.Extra-nasal external ethmoidectomy 3.Trans-antral ethmoidectomy 4.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

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 Antrochoanal polypEthmoid polyp Seen in adolescents & childrenAdult Etiology is infectionAllergic SingleMultiple UnilateralBilateral Shape is tri-lobed (dumbbell)Grape like Grows backwardForward Treatment is surgicalMedical + Surgical Recurrence is uncommonCommon

49 Thank You


Download ppt "Nasal Polyps Dr. Vishal Sharma. Nasal Polyp Hypertrophied, oedematous, prolapsed mucosa of nose & paranasal sinus. Properties of nasal polyp: Gray in."

Similar presentations


Ads by Google