Maxillary sinus-posterior nostril polyps are polyps originating from the maxillary sinus with a slender stemmed tip that protrudes posteriorly into the nostril. Maxillary sinus-posterior nostril polyp has its own pathological and clinical characteristics, and it is usually considered that it may be another polyp lesion distinct from the general nasal polyps. We retrospectively analyzed the clinical data of patients with maxillary sinus-posterior nostril polyps treated with nasal endoscopic surgery in recent years in our hospital, and the summarized data are reported as follows.
General information.
Among the 39 patients with maxillary sinus-posterior nasal foramen polyps admitted in recent years, 28 were male and 11 were female; age ranged from 11 to 52 years, with an average of 28 years, with the majority being aged 18 to 35 years (27/39 cases), and the duration of disease ranged from 4 months to 8 years.
Symptoms: 30 cases of unilateral nasal congestion, 9 cases of bilateral nasal congestion, 7 cases of nasal congestion with epistaxis, 16 cases of headache; 8 cases of sleep snoring, 6 cases of sleep apnea, and 10 cases of foreign body sensation in the pharynx.
Clinical signs:
There were 39 cases of grayish or reddish neoplasm in the nasal cavity, most of which had smooth surface; 6 cases of easy bleeding when touched; 6 cases of bloody nasal discharge; 4 cases of mucus discharge; 9 cases of lump in one cheek with pressure pain; 2 cases of nasal polyp with history of surgery.
In some cases, the anterior rhinoscopy showed a smooth grayish stem extending backward, and the turbinates were fully constricted with ephedrine swabs, and the stem could be seen to originate from the middle nasal passage, which was soft and movable to touch.
Some cases were scanned with a spiral CT machine with a layer thickness and layer spacing of 3 mm, a window width of 250 HU and a window position of 40 HU. Some cases were scanned with a bone window with a window width of 1200 HU and a window position of 250 HU. 39 cases were scanned in coronal position, 12 of which were scanned in axial position. The coronal scans ranged from the anterior border of the frontal sinus to the posterior border of the pterygoid sinus. The baseline of axial scans was parallel to the hard palate, and the scans ranged from the inferior border of the base of the maxillary sinus to the top of the frontal sinus, or the superior and inferior borders were decided according to the extent of the lesion.
Imaging performance:
Density and margins of lesions: CT scans revealed uneven density of lesions in 28 cases, 11 cases were low or slightly low-density predominantly mixed with high-density shadows, and the CT values of low-density foci were in the range of 21 to 36 HU. The margins of lesions were mostly clear and smooth, and shallow lobulation was occasionally seen. Bone changes: Bone changes included sinus wall bone compression and thinning, 18 cases were seen with distended enlargement of maxillary sinus, bone resorption destruction was more common in the inner wall, 3 cases involved in the medial wall, 2 cases in the posterior outer wall, 2 cases in the bottom wall, and 1 case in the anterior wall.
Methods: The diagnosis was determined according to preoperative X-ray sinus radiographs and CT examinations, and the surgical plan was prepared.
1.The polyps were removed from the common nasal passage to the posterior nasal orifice by nasal endoscopic technique through the middle nasal passage, or if the polyps were larger, they could be removed from the nasopharynx – oral cavity, followed by complete removal of the intra-sinus portion of the polyps at the maxillary sinus orifice.
2. The intra-sinus portion of the polyp is removed by endoscopic nasal sinus ostomy.
Results
At 2 weeks postoperatively, 35 cases (89.7%) had a clear nasal cavity and the headache and dizziness disappeared; at 3 weeks postoperatively, 36 cases (92.3%) had a clean nasal cavity without discharge; at 2 months postoperatively, 38 cases (97.4%) had a clear nasal cavity without headache, pus and bleeding, and no neoplastic growth; at 6 months postoperatively, 37 cases (94.8%) had no neoplastic nasal cavity and no nasal adhesions. 1 case recurred after 2 years. One case recurred after 2 years.
DISCUSSION
The etiology of this disease is not clear. The polyp originates in the maxillary sinus and then enters the nasal cavity through the sinus opening of the maxillary sinus in the middle nasal passage with a slender stemmed tip, sliding backwards towards the posterior nostril and may protrude into the nasopharynx.
Stammberger (1986) found that the polyp originated in the maxillary sinus cavity in the medial-superior corner near the sinus orifice using a nasal endoscope, and Kamel (1990) found that 13 of 22 posterior nostril polyps originated in the medial wall of the maxillary sinus using an endoscope, while the other 9 were difficult to locate because of the extensive mucosa of the sinus wall.
Berg (1988) found that the polyp was connected to the sinus wall cyst in the sinus cavity by exploring the maxillary sinus in 15 cases of posterior nasal meatus, so he concluded that the posterior nasal polyp originated from the sinus wall cyst of the maxillary sinus, which gradually increased in size and protruded into the nasal cavity through the sinus orifice and finally formed the posterior nasal meatus. Histological examination revealed that polyps often had more mucus glandular vesicles within the tissue, and some formed a large cyst. The cellular infiltrate is mainly a small amount of plasma cell infiltrate and rarely eosinophil infiltrate.
If the polyp is too large to be pulled out from the anterior nostril, the stem tip can be cut off near the middle nasal passage so that the large polyp in the posterior nostril can be spit out from the pharynx. However, precautions should be taken beforehand to prevent the polyp from falling into the laryngopharynx. It is best to enter the nasopharynx from the oropharynx under posterior rhinoscopic observation, clamp the polyp and pull it out.
Removal of the posterior nasal polyp alone does not prevent its recurrence; the intra-sinus portion must be removed as well. The commonly used method is the traditional Ko-Lu procedure. Neel (1984) described that the sinus stoma of the maxillary sinus of the inferior nasal tract is also good for removing the sinus portion of the polyp.
Ophir et al. (1987) suggested that the anterior half of the inferior turbinate could be removed before maxillary sinus ostomy to better expose the sinus cavity, and Kamel (1990) used a nasal endoscopic technique to remove the intra-sinus portion of the polyp through the sinus opening of the maxillary sinus in the middle nasal tract. Regardless of the method used, the diseased mucosa associated with the polyp should be removed from the sinus at the same time, leaving the healthy mucosa intact.