Endoscopic view of an anterior middle turbinate polyp.

A white 46-year-old woman complained that she had been having difficulty breathing through her right nostril for several years. She also said she had experienced intermittent sinusitis, which had been successfully treated with antibiotics. She denied any disturbance of smell.

Examination of the right nasal cavity revealed a poly-poid mass arising from the anterior end of the middle turbinate. The ostiomeatal complex was completely obstructed (figure, A). The right inferior turbinate and left nasal cavity were unremarkable, but the nasal septum was deviated to the right. Computed tomography of the sinuses showed a marked hypertrophy of the right turbinate and a right septal deformity. The paranasal sinuses were normal.

The patient was taken to the operating room, where a telescopic examination showed that the large polypoid mass had arisen from the right middle turbinate and was obstructing the right middle meatus (figure, A, arrow). Suction examination' revealed that the mass was freely mobile and was attached to the anterior end of the middle turbinate (figure, B). The mass was carefully removed with a microdebrider (figure, C), and the middle meatus became visible (figure, D). Retrograde uncinectomy revealed no obstruction of the ethmoid infundibulum and a patent natural ostium of the right maxillary sinus. The patient was symptom-free postoperatively.

Polyps arise in various parts of the nasal cavity, including the uncinate process, the ethmoid infundibulum, the ethmoid bulla, the frontal recess, the sphenoethmoid recess, the superior meatus, the middle turbinate, and the superior meatus. [2,3] unilateral polyps that arise from the anterior end of the middle turbinate are rare; when they do occur, they can cause a middle meatal obstruction, which can result in maxillary, ethmoid, or frontal sinusitis. A polypoid mass can be best diagnosed with a telescope and a suction tip.[1] A microdebrider is an ideal instrument for contouring the middle turbinate without destroying it as an anatomic landmark or interfering with its function. The cut surface of the turbinate will re-epithelialize smoothly.

References

(1.) 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.

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

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