الدكتور سعد يونس سليمان
Lecture objectivesNasal polyos A. Ethmoidal polyps B. Antrochoanal polyp Inflammation of the sinuses ( sinusitis ) Acute sinusitis. Complication of acute sinusitis
Nasal Polyps
Nasal polyps ( polypi ) are non- neoplastic masses of oedematous nasal or sinus mucosa. They are divided into two main varieties; Ethmoidal polypi Antrochoanal polypEthmoidal polyps
Are benign grayish, soft, translucent, multiple masses of pedunculated tissue Most often originate from the mucus membrane of the ethmoidal sinuses and project into the nasal cavity, resembling a bunch of grapes. They are usually bilateralThe aetiology of nasal polyps is poorly understood but classically they are caused by allergy and infection. It may also be associated with aspirin sensitivity and asthma, cystic fibrosis and Kartagener syndrome.
DIAGNOSIS:
It is a disease of adult Male affected more than female. Symptoms : * Nasal obstruction * Anosmia * Colourless or purulent anterior or posterior rhinorrhoea (post nasal drip) * Snoring * Headache due to chronic sinusitis that result from occlusion of sinus ostia.O/E Hyponasal voice Mouth breathing Flaring of alar cartilage ‘Frog face’ i.e. widening of the nasal bones if polyps develop in children before facial bone fuse . Anterior rhinoscopy; * Translucent , smooth-walled , grayish mass,. * Non-tender and moves backwards when probed. * Bilateral and multiple.
Investigations: The usual investigations are Radiography of the sinuses Allergy skin tests.
Treatment:
Medical treatment: About 50% of patients respond to steroid therapy ( local or systemic) . If no response after one month of treatment , then surgical treatment is recommended. Surgical treatment: Simple polypectomy. Internal ethmoidectomy under endoscopic control. External ethmoidectomy. Postoperative therapy; Recurrence of polyps is common, therefore local or systemic steroids are prescribed to prevent symptoms of rhinitis and prevent recurrence.Antrochoanal polyp
This polyp arises from the lining of the maxillary sinus and prolapses through the ostium in the middle meatus and extends backwards through the posterior choana to the nasopharynx. The choanal part of the polyp may be seen in the oropharynx.dumb-bell in shape often unilateral but may cause bilateral nasal obstruction good inspiratory airway with blockage on expiration. Anterior rhinoscopy may look normal The enlarged posterior end may only be seen on posterior rhinoscopy They are not associated with allergy and the aetiology is unknown
Radiography of the maxillary sinus
TreatmentThere is no medical treatment pre or post operatively Simple polypectomy; The polyp is delivered through the oropharynx and it is necessary to remove both parts of the polyp ( antral and intranasal ). Removal of the lining of the sinus; is necessary to avoid recurrence and this is achieved either through sinoscopy or by Caldwell-Luc procedure.
Ethmoidal polypi
Antrochoanal polypCommon in adult
Common in children
Age
Multiple
Solitary
Number
Bilateral
Unilateral
Laterality
Ethmoidal sinuses, middle turbinate and middle meatus
Maxillary sinus near the ostium
Origin
Mostly grow anteriorly and may present at the nares
Grows backwards to the choana; may hang down behind the soft palate
Growth
Usually small and grape-like masses
Trilobed (dumb-bell) with antral, nasal and choanal parts. Choanal parts may protrude through the choana & fill the nasopharynx obstructing both sides
Size and shape
Common
Uncommon if removed completely
Recurrence
About 50% of patients respond to steroid therapy
The treatment is only surgical
Treatment
SINUSITIS
INFLAMMATION OF THE SINUSES (Sinusitis )
Sinusitis is a very common disease. The maxillary sinus is the most commonly affected in adults, followed by the ethmoid , frontal and sphenoid sinuses. In children , the ethmoid sinuses are most frequently affected.Pathophysiology
Factors which impair the normal physiology of the paranasal sinuses are; (1) Obstruction of the sinus ostea a) Factors causing mucosal swelling b) Factors causing mechanical obstruction (2) Impaired function of the cilia Secondary.. Primary.. (3) Overproduction or change in the viscosity of secretionsACUTE SINUSITIS
Is defined as acute inflammation in the mucus membrane of the paranasal sinuses. It commonly follows common cold but may also follow dental infection, dental extraction, swimming and diving, trauma or after a nose operation. Bacterial infection quickly follows any viral infection Streptococcus Haemophilus influenzae Moraxella catarrhalis The maxillary sinus is more commonly affected than other group of sinuses … WHY?Clinical Presentation
There are two common clinical presentations depending on the virulence of the pathogens and the immune resistance of the patient; (1) A cold which lasts longer than 10 days ( viral infection rarely last longer than that ). (2) A cold that seems more severe than usual, with a high fever ( at least 39C ) and a purulent nasal discharge.Symptoms & Signs
Acute severe pain: Increase in bending forwards. Often non-specific and the whole face aches. In sphenoiditis ( uncommon) it is localized to the top of the head or over the trigeminal distribution. Pyrexia and general feeling of malaise. Copious nasal mucopurulent discharge. Nasal obstruction. Loss of smell. General feeling of fullness in the face. The nasal mucosa is often erythematous. Localized tenderness may indicate the group of sinuses involved, although in acute situation a pansinusitis is common .Investigations
The diagnosis is usually clinical , but the following may be helpful in confirming the diagnosis; Plain sinus radiograph; may show opacification or mucosal thickening. Raised WBC count and raised ESR. Positive blood culture and culture of nasal secretion.Treatment
** It is primarily medical and include (1) Antibiotics. (2) Decongestant. (3) Analgesic. Surgical drainage; The most important sinus to drain is the maxillary antrum as this is the ‘conductor of the orchestra’ Antral lavage . Intranasal antrostomy. Indwelling tube….