Endoscopic view of a nasal septal polyp.

Polyps can arise from any mucosal surface in the nose. According to Stammberger, the most common sites of origin are the ethmoid infundibulum and the mucosal contact areas of the uncinate process and middle turbinate. (1) Rarely do polyps arise directly from the nasal septum. (2)

A 72-year-old woman presented with symptoms of unilateral right nasal congestion. Her history included the development of numerous nasal polyps 31 years earlier, which were removed by conventional nasal and sinus surgery.

Computed tomography (CT) of the sinuses detected a soft-tissue mass arising from the nasal septum in the right nasal passage (figure, A). It also showed mild right maxillary sinusitis with mucosal thickening and a near-total absence of inferior turbinates on both sides. Endoscopic nasal examination showed that the mass was a large polypoid lesion (figure, B). Suction examination confirmed its origin in the septum. (3)

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The patient elected to have the obstructing septal polyp removed in an outpatient procedure under local anesthesia. The mass was removed with a microdebrider and a 0[degrees] telescope. No excessive bleeding occurred, and neither intranasal packing nor electrocautery was needed. The patient's postoperative course was uneventful, and her right nasal congestion resolved.

A finding of unilateral nasal obstruction caused by a large isolated polyp arising from the middle of the nasal septum is unusual.

References

(1.) Stammberger HR. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Philadelphia: B.C. Decker; 1991.

(2.) Yanagisawa E, Christmas DA, Yanagisawa R. Endoscopic view of the sites of origin of nasal polyps. Ear Nose Throat J 2000;79:490-2.

(3.) Yanagisawa E, Ho SY. Suction examination of the nasal cavity--A useful technique to detect hidden polyps. Ear Nose Throat J 1998;77:806-7.

Dewey A. Christmas, MD; Joseph P. Mirante, MD; Eiji Yanagisawa, MD

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas and Dr. Mirante); and the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group; the Section of Otolaryngology, Hospital of St. Raphael; and the Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn. (Dr. Yanagisawa).