Welcome   To ThePresentationOf group “A”
“Table of Contents”        1st part  “Anatomy of nasalcavity in relationship     with polp”       2nd partMain topic :nasa...
PART-1“ANATOMY OF NASAL CAVITY IN    RELATION TO POLYP”
MEDIAL WALL OF NASAL SEPTUMSkeleton of nasal septum is partly bone and partly cartilage.The bony part is formed by perpend...
LATERAL WALL OF NASAL SEPTUMThe lateral wall of the nasal cavity consist of prominent elevationSuperior concha Middle conc...
The spaces around concha are called meatusesThe inferior meatuslies below and lateral to inferior conchaMiddle meatuslies ...
Superior ethmoid bone that forms (upper and middle concha)Lower halfby vertical process of palatine bone and the body of m...
The openings or ostia through which the sinuses communicate with nasal cavity are coved with overl ining concha but after ...
Ethmoidal sinus:Can be divided into 3 partsAnterior part drain ant to hiatus semilunarisMiddle air cells drain into one or...
Sphenoidal sinus:One or more openings may be presnt drains into sphenoethmoidal sinus
Maxillary sinusdrains into middle meatus by an opening in the inferior part of hiatus semilunaris
Nasolacrimal ductOpening at inferior meatusCarries tears from eyes
MUCOUS MEMBRANE•Cilia and mucus along the inside wall of the nasal cavity trap remove dust and pathogens from the air as i...
Nasal cavitiesThe nasal cavities consist of two extensive chambers and theirassociated nasal sinuses. The two main chamb...
PART -2NASAL POLYP
NASAL POLYP  According to wikipedia:  “Nasal polyps are polypoidal masses arising mainly from the mucous  membranes of the...
Classification of polyp according to location                1.Bilateral ethmoid polypi                   2.antrochoanal p...
F)Kartagener’s syndrome G)young’s syndromeH)Churg-Strauss syndromeI)nasal mastocytosisPATHOGENESIS:Nasal mucosa ,perticula...
•  Sneezing and watery nasal discharge   due to associated allergy• Mass protruding from the nostrils.SIGNS:Anterior rhino...
TREATMENT• CONGESTIVE TREATMENT ―That is designed to avoid radical medical therapeutic measures or operative procedures.‖•...
TREATMENT• SURGERICAL TREATMENT“Surgery is an ancient medical specialty that uses operative manual and instrumental techni...
Polypectomy• 1 or 2 polyps which  are pedunculated are  removed with snare.• Multiple and sessile  polypi reqire special  ...
Intranasal ethmoidectomy• Done for multiple and  sessile polypi• Uncapping of  ethmoidal air cells by  intranasal route  r...
External nasal ethmoidectomy• Done if reoccurance of  polyps occur after  surgery• Approach is through  the medial wall of...
Transnasal ethmoidectomy• Done if infection and  polypoidal changes are  also seen in maxillary  antrum• Caldwell-luc appr...
Endoscopic sinus surgery   FESS(functional endoscopic sinus               surgery• Presently used• Polypi can be removed  ...
Classification of polyps according to site of                       origion•    1. Antrochoanal      – a. Single, Unilater...
ETIOLOGY:• Nasal Allergy• Sinus infectionSYMPTOMS:• Unilateral nasal obstruction May be bilateral if polyp grows in    nas...
PART-3CASE STUDY
CASE NUMBER 1:  A 36 years old patient presented with complaints of nasal obstructionwhich was mainly on the left side for...
EXTERNAL EXAMINATION:external examination of nose, face and eyes (watery eyes positive)CLINICAL EXAMINATION:•ANTERIOR RHIN...
CASE -2   A 28 years old female patient came with complaints of bilateral nasal obstruction ,excessive sneezing   And wate...
EXTERNAL EXAMINATION:external examination of nose, face and eyes (no positive findings) CLINICAL EXAMINATION: •ANTERIOR RH...
Bilateral ethmoidal
Point to remember:1- if polypus is red flshy, friable and has granular surface, especially in older patients think about  ...
DIFFERENTIAL DIAGNOSIS:1- A blob of mucus often looks like polypi but it would disappear on blowing the nose2-Hypertrophie...
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
Group a presentation 20th feb 2012
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college presentation about nasal polp for reviews email at drsana.ak@gmail.com

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  • Nasal cavitiesThe nasal cavities consist of two extensive chambers and their associated nasal sinuses. The two main chambers are separated by midline wall the nasal septum.
  • Group a presentation 20th feb 2012

    1. 1. Welcome To ThePresentationOf group “A”
    2. 2. “Table of Contents” 1st part “Anatomy of nasalcavity in relationship with polp” 2nd partMain topic :nasal polpi 3rd part Case study
    3. 3. PART-1“ANATOMY OF NASAL CAVITY IN RELATION TO POLYP”
    4. 4. MEDIAL WALL OF NASAL SEPTUMSkeleton of nasal septum is partly bone and partly cartilage.The bony part is formed by perpendicular plate of the ethmoid bone ,the vomer and smallvertical ridges from the superior surfaces of the palatine bone and maxillaAnterior septum is formed by septal vomerine and alar cartilage
    5. 5. LATERAL WALL OF NASAL SEPTUMThe lateral wall of the nasal cavity consist of prominent elevationSuperior concha Middle conchaInferior conchaConchas narrow the nasal passage create large surface area foricng inhaled air to pass around and over them which helps in warming n moisting of airChonca are projections of bones from lateral wall of the nasal cavity covered by mucous membrane
    6. 6. The spaces around concha are called meatusesThe inferior meatuslies below and lateral to inferior conchaMiddle meatuslies below and lateral to middle conchaSuperior meatuslies below n lateral to superior conchaSpace above sup erior concha is Sphenoethmoidal recess
    7. 7. Superior ethmoid bone that forms (upper and middle concha)Lower halfby vertical process of palatine bone and the body of maxillary boneInerior concha is a separate boneAnteriorly the lateral wall is formed by nasal bone and lateral nasal and alar cartilages
    8. 8. The openings or ostia through which the sinuses communicate with nasal cavity are coved with overl ining concha but after removal of concha can be seenFrontal sinusdrains into infundibulum , a furnel like turnel that opens into the upper end of hiatus semilunaris .
    9. 9. Ethmoidal sinus:Can be divided into 3 partsAnterior part drain ant to hiatus semilunarisMiddle air cells drain into one or more openings in bubble like structure ethmoidal bullaPosterior air cells drain by one or more opening into the superior meatus
    10. 10. Sphenoidal sinus:One or more openings may be presnt drains into sphenoethmoidal sinus
    11. 11. Maxillary sinusdrains into middle meatus by an opening in the inferior part of hiatus semilunaris
    12. 12. Nasolacrimal ductOpening at inferior meatusCarries tears from eyes
    13. 13. MUCOUS MEMBRANE•Cilia and mucus along the inside wall of the nasal cavity trap remove dust and pathogens from the air as it flows through the nasal cavity.• The cilia move the mucus down the nasal cavity to the pharynx, where it can be swallowed. •The nasal mucous membrane lines the nasal cavities, and is adherent to the periosteum or perichondrium. The epithelium is divided into : • Respiratory epithelium: (consisting of mucous secreting goblet cells and ciliated cells) • Olfactory epithelium: (bipolar nerve cells the olfactory cells)
    14. 14. Nasal cavitiesThe nasal cavities consist of two extensive chambers and theirassociated nasal sinuses. The two main chambers are separated by midline wall the nasalseptum.The cavities are lined by mucus membrane,contains sebaceous glandshair follicles called VIBRISSAE
    15. 15. PART -2NASAL POLYP
    16. 16. NASAL POLYP According to wikipedia: “Nasal polyps are polypoidal masses arising mainly from the mucous membranes of the nose and paranasal sinuses. They are overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely movable and non tender.” ORAccording to authentic medical dictionary―A polyp is the medical term for any overgrowth of tissue from the surface of abody organ. Polyps come in all shapes—round, droplet, and irregular being themost common. Nasal polyps are teardrop-shaped while growing and resemblepeeled grapes when they have reached their full size.The condition of nasal polyps is sometimes called nasal polyposis.‖ ORText book describes it as:―Nasal polypi are non –neoplastic masses of oedematous nasal or sinous mucosa.‖
    17. 17. Classification of polyp according to location 1.Bilateral ethmoid polypi 2.antrochoanal polyp1.Bilateral Ethmoidal polypi• Bilateral,multiple in number,usually small grape like mass• Usually found in adults.• Originate from ethmoidal sinuses,uncinate process, middle turbinate and middle meatus• Mostly grow anteriorly may present at nares• Reoccurence commonETIOLOGY:• A)chronic rhinosinusitis• B)Asthma (risk factor)• C)Asprin intolerence• D)cystic fibrosis• E)Allergic fungal sinusitus
    18. 18. F)Kartagener’s syndrome G)young’s syndromeH)Churg-Strauss syndromeI)nasal mastocytosisPATHOGENESIS:Nasal mucosa ,perticularly in the region of middle meatus and turbinate becomes oedematus due to collection of ECF.PATHOLOGY:A) Early :surface of nasal polp I is covered byciliated coloumnar epithelium (normal nasal mucosa)B) Late : it undergoes metaplastic change to transitional and squamous type on exposure to atmospheric irritationSubmucosa shows large intercellular spaces filled with serous fluid.Infiltration with eosinophillsSYMPTIOMS:Nasal stiffness that leads to nasal obstructionPartial or total loss of smellHeadache due to associated sinusitis
    19. 19. • Sneezing and watery nasal discharge due to associated allergy• Mass protruding from the nostrils.SIGNS:Anterior rhinoscopy : Polpi appears as smooth, glistering, grape-like mass often pale in colour . May be sessile or penduculated. Insensitive to probing. Do not bleed on touch.DIAGNOSIS:1) Clinical examination2) CT scan for correct analysis of extent and also helps to plan surgery
    20. 20. TREATMENT• CONGESTIVE TREATMENT ―That is designed to avoid radical medical therapeutic measures or operative procedures.‖• Control of allergy• Anti histaminicsShort course of steroids (for those who cant tolerate anti histaminics or asthma)CONTRAINDICATION OF STEROIDS1. Hypertension2. peptic ulcer3. Diabetes4. Pregnancy5. Tuberculosis
    21. 21. TREATMENT• SURGERICAL TREATMENT“Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.‖For removal of nasal polyps:1.Polypectomy2.Intranasal ethomoidectomy3.Extranasal ethmoidectomy4.Transnasal ethmoidectomy5.Endoscopic sinus surgery
    22. 22. Polypectomy• 1 or 2 polyps which are pedunculated are removed with snare.• Multiple and sessile polypi reqire special forceps.
    23. 23. Intranasal ethmoidectomy• Done for multiple and sessile polypi• Uncapping of ethmoidal air cells by intranasal route required
    24. 24. External nasal ethmoidectomy• Done if reoccurance of polyps occur after surgery• Approach is through the medial wall of the orbitby an external incision ,medial to medial canthus
    25. 25. Transnasal ethmoidectomy• Done if infection and polypoidal changes are also seen in maxillary antrum• Caldwell-luc approach is used
    26. 26. Endoscopic sinus surgery FESS(functional endoscopic sinus surgery• Presently used• Polypi can be removed more accurately when ethmoidal cells are removed, and drainage and ventilation provided to the othe involved sinuses.• Done with endoscope of 0,30,70 degree
    27. 27. Classification of polyps according to site of origion• 1. Antrochoanal – a. Single, Unilateral – b. Can originate from maxillary sinus near ostium – It has 3 parts Antral which is a thin stalk Choanal which is round and globular Nasal which is flat from side to side – c. Usually found in children. – Grows backward to choana may hang down behind the soft palaet. – Trilobed with antral, nasal and choana & fill the nasopharynx obstruction both sides – Reoccurrence uncommon, if removed completely
    28. 28. ETIOLOGY:• Nasal Allergy• Sinus infectionSYMPTOMS:• Unilateral nasal obstruction May be bilateral if polyp grows in nasopharynx• Voice may be thick and dull due to hyponasality• Nasal dischargeSIGNS:Anterior rhinoscopy:• As it grows posteriorly can be missed at anterior rhinoscopy• A smooth greyish mass can be seen,it is soft and can be moved up and down with a prob. TREATMENT:Polypectomy,endoscopic removalor caldwell-luc operation
    29. 29. PART-3CASE STUDY
    30. 30. CASE NUMBER 1: A 36 years old patient presented with complaints of nasal obstructionwhich was mainly on the left side for last 1 year .It was often associatedwith left sided facial pain, left side watering of eye,frontal headache and thick, clear nasal discharge. reliving factor include medication and his symptoms were relived upto short extent of time. Anterior rhinoscopy showed soft, smooth and pale mass in left nasal cavity • IMPORTANT POINTS IN HISTORY TAKING: • Nasal obstruction • (onset, duration, progression, unilateral or bilateral, continuous or intermittent, aggravating and relieving factors) • Nasal discharge(colour ,frequency, consistency) • Allergy or asthma, excessive sneezing, watery rhinorrhea, dyspnoea • Watering from eyes • Nasal surgery
    31. 31. EXTERNAL EXAMINATION:external examination of nose, face and eyes (watery eyes positive)CLINICAL EXAMINATION:•ANTERIOR RHINOSCOPY : presence of mass in left nasal cavity filling it completely•PROBE TEST : mass was soft, mobile, polypoidal, insensitive to touch, but did not bleed•NASAL PATENCY TEST: absent on left side•POSTERIOR RHINOSCOPY : mass was not visibleINVESTIGATIONS:1)X-rays PNS(water’s view) will show opacification in left maxillary sinus and with soft tissuein left nasal cavity.2) CT Scan show soft tissues arising from left maxillary sinus involving nasal cavity and nasopharynx3)For general anaesthesia e.g blood CP, prothrombin time, activated partial thromboplastin time andUrine D/R :all were in normal limitsDIAGNOSIS:Antrochoanal polp involvinf left maxillary sinus nasal cavityand nasopharynxTREATMENT :Convensional intranasal polypectomy ORFunctional endoscopic sinus surgery
    32. 32. CASE -2 A 28 years old female patient came with complaints of bilateral nasal obstruction ,excessive sneezing And watery rhinorrhoea for past 8 to 10 years now nasal obstruction has increased markedly to become almost continuous and she can not breath through her nose. On clinical examination the nose was pale, multiple and bilateral polypi were present in nasal cavities.•IMPORTANT POINTS INHISTORY TAKING:•Nasal obstruction(onset, duration, progression, unilateral orbilateral, continuous orintermittent, aggravating andrelieving factors)•Nasal discharge(colour,frequency, consistency)•Allergy or asthma, excessivesneezing, wateryrhinorrhea, dyspnoea•Watering from eyes•Nasal surgery
    33. 33. EXTERNAL EXAMINATION:external examination of nose, face and eyes (no positive findings) CLINICAL EXAMINATION: •ANTERIOR RHINOSCOPY: It revealed multiple, pale, smooth and shiny grape like polypi completely filling both nasal cavities •PROBE TEST : mass was soft, mobile, polypoidal, insensitive to touch, but did not bleed •NASAL PATENCY TEST: absent on both side •POSTERIOR RHINOSCOPY : nasopharynx was clear INVESTIGATIONS: 1) CT Scan shows presence of polypi in both nasal cavities with involvement of both ethmoidal air cells and maxillary sinuses 2)For general anaesthesia e.g blood CP, prothrombin time, activated partial thromboplastin time and Urine D/R :all were in normal limits 3)Peripheral eosinophil count and total serumIge level both were increased DIAGNOSIS: Bilateral ethmoidal nasal polypi TREATMENT : Convensional intranasal polypectomy OR Functional endoscopic sinus surgery Histopathological examination of polyp
    34. 34. Bilateral ethmoidal
    35. 35. Point to remember:1- if polypus is red flshy, friable and has granular surface, especially in older patients think about MALIGNENCY2-All polyps should be subjected to histology3-A simple polp in achild may be a glioma , an encephalocele or a meningoencephalocele.It should always be aspirated and fluid examination for CSF should be done.careless removal of suchPolyp would cause CSF rhinorrhoea and meningitis .4-Multiple nasal polyps in children may be associated with mucoviscidosis5-Epistaxis and orbital syndrome associated with polyp shouldalways arouse the suspicion of malignancy malignancy
    36. 36. DIFFERENTIAL DIAGNOSIS:1- A blob of mucus often looks like polypi but it would disappear on blowing the nose2-Hypertrophied turbinate is differentiated by its pink appearance and hard fell on probe testing3-Absence or presence of bleeding history e.g angiofibroma has history of profuse recurrentepistaxis.4- Other neoplasm can be differentiated by their fleshy pink appearance, friable nature and theirtendency to bleedNeoplasm Hypertrophied turbinate epistaxis

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