Nasal Polyp 2014 - fess

8/16/2019 Nasal Polyp 2014 - fess

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Definition:

Non -Neoplastic mass of edematous nasal/sinus submucosa forms when theoedematous stroma ruptures and herniates through the basement membrane

Theory (not proven):the exact etiology is not known yet

Fibrosis causing lymphatic obstruction

Histopathology:

1. marked edema of the connective tissue stroma 2. Inflammatory mediators such a: s histamine, prostaglandins and leukotrienes.3. marked eosinophilic and histiocytic infiltrate4. epithelium displays goblet cell hyperplasia 5. lining mucosa is ciliated columnar but due to atmospheric irritation it may

undergo squamous cell metaplasia

Features:

1. Bilateral: simple inflammatory polyp usually are bilateral 2. soft 3. gelatinous 4. initially sessile then Pedunculated5. pale 6. do not bleed on probing / do not shrink with the use of vasoconstrictor 7. insensitive to pain 8. Long-standing cases present with broadening of nose and increased intercanthal

distance (frog face deformity)

Features suggestive of malignancy in a polyp:

1. Unilateral 2. Fleshy 3. ulcerated 4. Produce bloody discharge 5. Cause pain 6. Cervical metastasis

Nasal Polyp



Potential Complications of Nasal Polyposis:

1. Anosmia2. Osteitis3. Cranial nerve neuropathy

4. proptosis

Profile:

A. M more than FB. Age 30-60: if there is nasal polyp in a child suspect

Cystic fibrosis/ Immune Deficiency

C. Occur mainly in non-allergic noninfectious eosinophilic Rhinitis



Site of origin

Staging of the polyp:

Always arise from the lateral wall of nose (ethmoid sinus). Common sites are uncinate process, bulla ethmoidalis, ostia of sinuses, medialsurface and edge of middle turbinate.

Allergic nasal polypi almost never arise from the septum or the floor of nose



Types:

1. Bilateral ethmoidal polyp.2. Antrochoanal polyp

Ethmoidal polyps:

1. Chronic rhinosinusitis :

Polypi are seen in chronic rhinosinusitis of both allergic and non-allergicorigin. Non-allergic rhinitis with eosinophilia syndrome (NARES) is aform of chronic rhinitis associated with polyp.

2. Allergic fungal sinusitis : Almost all cases of fungal sinusitis form nasal polyp.

3. Asthma : 7% of pt with asthma will develop polyp

4. Aspirin intolerance: 36% of the patients with aspirin intolerance may show polypi. Sampter's triad consists of:

1. nasal polypi2. asthma3. aspirin intolerance. Have more sever symptoms Higher risk of recurrence post surgery

May benefit from low Salicylate diet (avoid potato,olive oil,wine)

5. Churg-Strauss syndrome : Consists of asthma, fever, eosinophilia, vasculitis and granuloma.

6. Cystic fibrosis: 20% of patients with CF form polyp. It is due to abnormal mucus .

7. Kartagener's syndrome : consists of bronchiectasis ,sinusitis, situs inversus and ciliary dyskinesis.

8. Young's syndrome : It consists of sinopulmonary disease and azoospermia.

9. Nasal mastocytosis : It is a form of chronic rhinitis in which nasal mucosa is infiltrated with

mast cells but few eosinophils. Skin tests for allergy and IgE levels are normal .

DiagnosisDiagnosis can be easily made on clinical examination.

CT scan of paranasal sinuses is essential to exclude the bony erosion and expansionsuggestive of neoplasia



Treatment of simple polyp:

a. medical management:

1. topical corticosteroids decrease capillary permeability decrease excretion in response to cholinergic stimulation suppress cytokine synthesis in eosinophil, basophil and

lymphocytes inhibit influx of eosinophil and basophil into nasal epithelium anddecrease

production of inflammatory mediators arachidonic acid production

2. oral corticosteroids used for recurrent conditions short high burst with rapid taper



b. surgical management:1. polypectomy2. FESS

indication: Failure to response to medical treatment

Require frequent oral steroid

Treatment of antrochoanal polyp

1. Trans-nasal endoscopic removal is tried first2. in case of recurrence to Caldwell luc surgery

Note the opening of the antrum is wide open

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Nasal Polyp 2014 - fess