Endoscopic view of an obstructing polyp of the uncinate fold.

A 38-year-old woman presented with a history of recurring left facial pain associated with a purulent left nasal discharge. She had been experiencing episodes on and off for 2 years. Her family physician had treated her on numerous occasions with several antibiotics, which resulted in temporary relief of symptoms.

Because of the recurring nature of the problem, the primary care physician referred the patient to us for further evaluation. Computed tomography (CT) of the sinuses demonstrated opacification of the left maxillary sinus, obstruction of the left middle meatus, and ethmoid sinusitis (figure, A). Endoscopic nasal evaluation detected a polypoid mass arising from the left uncinate fold (figure, B). The patient chose to undergo surgery, and the mass was carefully identified and removed with a microdebrider (figure, C). The inferior uncinate fold was also partially removed, which allowed for good access to the infundibulum (figure, D). The removal of the obstructing polypoid tissue allowed for adequate drainage of the maxillary sinus and infundibulum. At follow-up 1 year later, the patient reported no further pain or drainage.

[FIGURES A-D OMITTED]

Polyps are the most common benign lesions of the nasal cavity, and they are a frequent finding in patients with recurrent sinusitis. Most intranasal polyps originate in the ethmoid sinus or nearby, but they can arise on any mucosal surface in the nose or sinuses. (1,2) Polyps originating in the uncinate fold, such as the one seen in this case, have been described by Yanagisawa et al. (2)

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.

Joseph P. Mirante, MD; Dewey A. Christmas, 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. Mirante and Dr. Christmas): 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).