powerpoint presentation… · ppt file · web view · 2011-02-142011-02-14 · listening smooth...
TRANSCRIPT
![Page 1: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/1.jpg)
Nasal PolypsDr. Vishal Sharma
![Page 2: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/2.jpg)
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
![Page 3: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/3.jpg)
Antro-choanal Polyp
![Page 4: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/4.jpg)
Clinical Presentation
Adolescent / child
Unilateral nasal obstruction
Unilateral nasal discharge
![Page 5: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/5.jpg)
Differential diagnosis• Hypertrophied inferior turbinate
• Blob of mucous
• Inverted papilloma
• Rhinosporiosis & rhinoscleroma
• Angiofibroma
• Meningocoele
• Malignancy
![Page 6: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/6.jpg)
Nasal mass
![Page 7: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/7.jpg)
Oropharynx examination
![Page 8: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/8.jpg)
Oropharynx examination
![Page 9: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/9.jpg)
Posterior rhinoscopy
![Page 10: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/10.jpg)
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
![Page 11: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/11.jpg)
Probe testAntrochoanal polyp Hypertrophied turbinate
Insensitive to pain Sensitive
Probe can be passed all around
Cannot be passed
Mobile Not mobile
![Page 12: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/12.jpg)
Etiology & originEtiology:
– Infective maxillary sinusitis
– Anomaly of maxillary sinus ostium
Origin:
• Arises from maxillary sinus mucosa & exits
via its natural or accessory ostium
![Page 13: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/13.jpg)
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
![Page 14: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/14.jpg)
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)
![Page 15: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/15.jpg)
Diagnostic Nasal Endoscopy
![Page 16: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/16.jpg)
Diagnostic Nasal Endoscopy
![Page 17: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/17.jpg)
X-ray Paranasal Sinus
![Page 18: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/18.jpg)
C.T. scan Paranasal Sinus
![Page 19: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/19.jpg)
C.T. scan Paranasal Sinus
![Page 20: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/20.jpg)
Treatment
• Antibiotics (pre & post operatively)
• F.E.S.S. (avulsion polypectomy with middle
meatal antrostomy)
• Caldwell – Luc operation (for recurrence)
![Page 21: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/21.jpg)
How to prevent recurrence
• Complete removal of all parts
• Wide middle meatal antrostomy (widening of
maxillary sinus ostium)
• Post-operative antibiotics
![Page 22: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/22.jpg)
Parts of Killian’s A.C. polyp• Antral: globular
• Nasal: flattened
transversely
• Choanal: globular
• Neck: present at
maxillary ostium
![Page 23: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/23.jpg)
Middle meatal antrostomy
![Page 24: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/24.jpg)
Caldwell – Luc Operation
![Page 25: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/25.jpg)
Ethmoid Polyp
![Page 26: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/26.jpg)
Clinical PresentationAdult patient
• Bilateral nasal obstruction
• Bilateral watery nasal discharge
• Excessive, paroxysmal sneezing
• H/o previous nasal surgery
![Page 27: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/27.jpg)
B/l nasal mass
![Page 28: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/28.jpg)
Anterior rhinoscopy
![Page 29: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/29.jpg)
Broadening of nasal bridge
![Page 30: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/30.jpg)
Etiology of ethmoid polyp1. Allergy
2. Allergy + Infection
3. Vasomotor imbalance
4. Bernoulli phenomenon
5. Poly-saccharide changes
![Page 31: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/31.jpg)
Associated diseases1. 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)
![Page 32: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/32.jpg)
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
![Page 33: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/33.jpg)
Diagnostic Nasal Endoscopy
![Page 34: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/34.jpg)
Diagnostic Nasal Endoscopy
![Page 35: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/35.jpg)
Diagnostic Nasal Endoscopy
![Page 36: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/36.jpg)
CT scan Paranasal Sinus
![Page 37: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/37.jpg)
Non-surgical TreatmentGiven 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)
![Page 38: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/38.jpg)
Pre-steroid vs. Post-steroid
![Page 39: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/39.jpg)
Surgical Treatment1. Intra-nasal avulsion polypectomy
2. Extra-nasal external ethmoidectomy
3. Trans-antral ethmoidectomy
4. Functional Endoscopic Sinus Surgery
Conventional Micro-debrider Laser
![Page 40: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/40.jpg)
F.E.S.S.
![Page 41: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/41.jpg)
F.E.S.S. instruments
![Page 42: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/42.jpg)
F.E.S.S. with navigation
![Page 43: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/43.jpg)
Micro-debrider
![Page 44: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/44.jpg)
Micro-debrider
![Page 45: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/45.jpg)
How to prevent recurrence1. Complete removal of all polyps
2. Avoid allergens
3. Post-operative course of:
• Oral antihistamines (1-3 months)
• Corticosteroid nasal sprays (3-6 months)
![Page 46: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/46.jpg)
Bilateral FESS cavities
![Page 47: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/47.jpg)
Post FESS CT scan
![Page 48: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/48.jpg)
Antrochoanal polyp Ethmoid polypSeen in adolescents & children AdultEtiology is infection Allergic
Single Multiple
Unilateral Bilateral
Shape is tri-lobed (dumbbell) Grape like
Grows backward Forward
Treatment is surgical Medical + Surgical
Recurrence is uncommon Common
![Page 49: PowerPoint Presentation… · PPT file · Web view · 2011-02-142011-02-14 · listening Smooth surface ... Laser. F.E.S.S. ... PowerPoint Presentation](https://reader038.vdocuments.net/reader038/viewer/2022102822/5aa533807f8b9a7c1a8d0c1e/html5/thumbnails/49.jpg)
Thank You