Mr. Zhang is 53 years old, is a hospital employee, 4 years ago unit health check, the doctor found the left side of the nasal cavity edema-like swelling, recommended surgery. Two years ago, he had blood in his nose by chance, and the doctor took part of the swelling and examined it as a nasal polyp, and after surgery, the swelling was completely removed, and the pathology was found to be a nasal invagination papilloma, with local malignancy. He received further treatment after surgery, and although he is recovering well, he is still under close follow-up by the doctor.
A polyp in the nose is medically known as a nasal polyp. Nasal polyps are formed when the mucous membrane in the nasal cavity swells and loses its normal function. After a cold, the nose does not breathe, which is the result of the swelling of the mucous membrane in the nasal cavity. After the application of oral medication or local nasal drops, the swelling of the mucous membrane in the cavity will subside, and the nose will be ventilated again. However, repeated swelling of the mucous membrane in the nasal cavity will lose elasticity like a balloon filled with water for a long time and cannot recover, forming nasal polyps.
The nasal cavity is surrounded by a number of bony cavities called sinuses, including the pterygoid, septal, frontal and maxillary sinuses. The formation of some nasal polyps is related to the edema of the mucosa in these sinus cavities falling into the nasal cavity. Many nasal polyp patients are very distressed because the “root” of the polyp is in these bones, so some people describe nasal polyp surgery like cutting leeks, cutting one crop after another.
The main manifestation of nasal polyps is that the nose is not ventilated, can not smell, and speak with a nasal sound. Hemorrhagic nasal polyps will have nasal bleeding. When nasal polyps are found, they should be treated surgically. Since the nasal cavity is adjacent to the eye and brain, surgery is risky, especially because it is separated from the eye by a very thin bone plate, called a paper-like plate, which can be easily damaged if not done carefully during surgery. It is not uncommon to report blindness after nasal polyp surgery. Nasal polyp surgery requires anesthesia. Depending on the hospital conditions, general anesthesia or local anesthesia can be chosen. Generally, when the surgery is performed under local anesthesia, the patient is awake and the tension will aggravate the pain. General anesthesia surgery is a painless surgery with the help of an anesthesiologist. Hospitals that have the conditions can perform controlled hypotension at the same time as general anesthesia, which results in less intraoperative bleeding, a clear operative field, and fewer complications. If under general anesthesia, the nasal cavity is then given with a certain proportion of local anesthetic and vasoconstrictor drug preparation of cotton surface anesthesia, the effect will be better.
Nowadays, nasal polyp surgery is performed in the nasal cavity without incisions on the surface skin. With the promotion of sinus endoscopic surgery technology, it has become a routine operation. Under good surgical conditions, an experienced surgeon can complete it within an hour and a half, or even half an hour, and the patient recovers quickly after the operation because of the painlessness and the short operation time with little intraoperative bleeding. During the surgery, the surgeon will usually put the lesion tissue removed from the nasal cavity and sinuses into a bowl containing saline. If the cut tissue is found floating in the bowl, it is often fatty tissue, suggesting damage to the orbital cardboard, and the patient will have a purple shadow on the skin around the orbit after the surgery, clinically known as ‘panda eyes’. With the development of medicine, the application of CT, doctors can clarify the relationship between nasal polyps and the eye and skull base before surgery, and the safety of surgery is greatly improved.
Prevention of nasal polyps is the fundamental to avoid the pain of nasal polyps. First of all, reduce the number of colds to avoid recurrent edema of the nasal mucosa. A disease closely related to nasal polyps is allergic rhinitis. These patients often experience itchy nose, sneezing and runny nose during certain seasons of the year, when they smell certain odors or when they encounter changes in hot or cold air. In hospitals, doctors often encounter patients with nasal polyps, asthma, and allergy to aspirin (fever reducers) at the same time, called the aspirin triad. After nasal polyp surgery, patients should strictly follow the doctor’s requirements and go to the hospital for regular checkups. If the doctor finds small mucosal edema, it will be removed in time to avoid another major surgery. In addition, post-operative patients should take medication promptly after a cold to prevent recurrence of nasal polyps caused by local irritation of pus from sinusitis.
Patients whose nose is not breathable, if the doctor finds something growing inside the nasal cavity, it may not always be a nasal polyp. In addition to the possible nasal polyps, people of different ages have other diseases may,. In infants and young children, nasopharyngeal fibrovascular tumor, middle-aged and elderly patients with nasal invagination papilloma, and even some patients with nasal cancer, nasopharyngeal cancer, or nasal polyps with local malignant changes, may be misdiagnosed. Therefore, pathological examination of surgically removed ‘nasal polyp’-like tissue must be done to exclude the possibility of malignant transformation. Especially for patients with unilateral nasal masses, doctors often take partial biopsies of the masses for laboratory tests before surgery.