Endoscopic view of the sites of origin of nasal polyps.

Polyps are the most frequently encountered benign lesions of the nasal cavity. They are often responsible for persistent or recurrent sinusitis that is resistant to medical therapy. Obstructing nasal polyps are the most common indication for surgical intervention. [1,2]

Almost all intranasal polyps originate in the ethmoid region or its immediate vicinity. Polyps can arise from the uncinate process (figure, A); the ethmoid infundibulum (figure, B); the ethmoid bulla (figure, C); the frontal recess (figure, D); the suprabullar and retrobullar recesses; the superior and inferior hiatus semilunaris; the superior, middle, and inferior turbinates and meatus (figure, G, H, I). According to Stammberger, the most common sites of origin of nasal polyps are the contact areas of the uncinate process and middle turbinate and the ethmoid infundibulum. [1] In the case of the middle turbinate, polyps can involve the anterior, inferior, lateral, and medial aspects.

Some polyps in the middle meatus arise from the maxillary sinus and enter the middle meatus through the maxillary sinus ostia or via a middle meatal antrostomy. Likewise, inferior meatal polyps can originate in the maxillary sinus and enter the inferior meatus via a postoperative inferior meatal window. Rarely do polyps arise from the posterior aspect of the nasal septum (figure, E), the olfactory cleft, or the sphenoethmoid recess (figure, F) in cases of massive nasal polyposis [1,2]

The sites of origin of nasal polyps should be carefully examined endoscopically, both in the office and in the operating room. Suction examination is useful to confirm the diagnosis of nasal polyps and to detect hidden polyps in the nasal meatus and behind the turbinates. Remember, polyps are usually freely mobile when manipulated with a suction tip, whereas other intranasal structures are not. [3]

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

References

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

(2.) Yanagisawa E. Atlas of Rhinoscopy: Endoscopic Sinonasal Anatomy and Pathology. San Diego: Singular/Thomson Learning, 2000.

(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.