Best therapies for the treatment of nasal polypectomy in India-video

India is one of the best places for nasal polypectomy or any other type of nasal medical treatment, around the world. Every year thousands of visitors around the world are coming to India for the medical treatment on nasal polypectomy or other type of sinus related problems. The reason for the global appreciation is because India has got the world eminent doctors & hospitals where all the services are provided to the patients. In addition to that India has one of the largest pharmaceutical industries in the world. By making use of this latest technical apparatus and the services of highly expert medical personnel, the Indian hospitals are in a position to provide a spectrum of general as well as specialist's services.

Nasal polypectomy is the surgical removal of polyps that are located in the nasal passages. If polyps recur, it may be necessary to remove polyps from the deeper ethmoid, sphenoid, and maxillary sinus linings to provide longer-lasting relief. Nasal polypectomy are caused by an overproduction of fluid in the mucous membranes, polyps are seen with asthma, allergic rhinitis (hay fever), vasomotor rhinitis and certain kinds of drug use and chronic sinus infections.

Symptoms of nasal polypectomy

• Nasal obstruction
• A runny nose
• Chronic sinus infection
• Dull headaches
• Snoring
• Persistent stuffiness
• Difficulty in breathing
• Re-occurring sinus infections

Causes of nasal polypectomy

• Continuous inflammatory process within the nose and sinuses
• Overproduction of fluid in the sinus and nasal membranes cause polyps to become swollen and engorged with fluid
• Engorged nasal membranes

Procedure

Nasal polypectomy is a procedure designed to open the natural drainage pathways of the sinuses to restore their function and health. In chronic nasal polypectomy, the sinuses are unable to drain adequately due to inflammation of the drainage pathways. As a result, nasal secretions become trapped in the sinuses and become chronically infected.

After an initial endoscopic check, the first step of the nasal polypectomy is to do an uncinectomy. An incision is made on the uncinate process, starting at the level of the upper attachment of the middle turbinate and ending just above the inferior turbinate. The uncinate process is then removed with a twisting movement, thus uncapping the infundibulum. This preliminary step of the nasal polypectomy is the most important. Incomplete or improper removal of the uncinate will cause difficulty not only with further dissection of the ethmoid cells, but can also make identification of the maxillary sinus ostium difficult. An incompletely removed uncinate process is perhaps the most common finding in revision cases and the cause for surgical failure.

The bulla ethmoidalis is now seen and removal of the anterior ethmoidal air cells is undertaken. The bone forming these cells is very thin and one can remove it quite easily and gently using ethmoid forceps. It is important to clear the sinus lateralis, which is a space of variable size, extending between the bulla and the roof of the ethmoidal sinus medial to the lamina papyracea, lateral to the middle turbinate, and posteriorly between the bulla and the ground lamella. This will ensure complete clearance of the anterior ethmoids, define the boundaries of dissection and guard against possible recurrence.

It should be noted that during the nasal polypectomy, the roof of the ethmoids which separates the air cells from the dura, curves upwards as it goes laterally. While dissecting in this region it is always safer to keep the forceps pointed laterally, away from the cribriform plate area. Laterally, the dissection stops at the lamina papyracea, which is identified by its yellowish tinge. If the lamina papyracea is perforated accidentally the patient will complain of pain in the eye and fat will prolapse into the nasal cavity if the orbital periosteum has also been damaged. Posteriorly, the dissection is completed till the ground lamella, which is a bony partition between the anterior and posterior ethmoid cells. The ground lamella is actually the postero-lateral attachment of the middle turbinate. It is also necessary to clear the frontal recess area. The anterior ethmoidal cells, which are situated around the frontal recess and anterior to the anterior ethmoidal artery, are removed using an endoscope and upward biting forceps. After clearing the anterior cells it is possible to see the opening of the frontal sinus, which should be unblocked by removing diseased mucosa surrounding it. During endonasal frontal sinusotomy, a solid piece of bone is occasionally encountered anterior to the neo-ostium.

The next step in the nasal polypectomy is to widen the natural ostium of the maxillary sinus. The sinus ostium should be found easily once the anterior ethmoidectomy has been completed and provided the uncinate has been completely removed. Often however, there may be oedematous or polypoidal mucosa obscuring the sinus opening. During nasal polypectomy the surgeon should be careful to remain just above the attachment of the inferior turbinate to avoid inadvertent damage to the lamina papyracea and the orbital contents which are situated at a slightly higher level. Sometimes during sinuscopy, it is almost impossible to identify the ostium of the maxillary sinus especially when the mucosa is swollen. Once the natural ostium is identified, punching out its bony walls using Ostrum’s reverse cutting forceps widens it. As long as the antrostomy window remains posterior to it, the nasolacrimal duct will not be damaged. A branch of the sphenopalatine artery lies in the region of the posterior fontanelle and bleeding may occur if the ostium is widened posteriorly. If direct visualisation of the maxillary sinus is required, a canine fossa puncture with a trocar and canula can be done.

The posterior ethmoids are entered by gently perforating the basal lamella. The posterior ethmoidal cells are carefully removed till the anterior wall of the sphenoid is reached. The sphenoid sinus is entered by perforating its anterior wall and widening the opening. This must always be done in an infero-medial direction from the posterior ethmoids to prevent inadvertent injury to the dura. After removing the sphenoid sinus the nasal polypectomy ends.

Complications associated with nasal polypectomy

• Frequent or chronic sinus infections.
• Obstructive sleep apnea, a potentially serious condition in which you stop and start breathing a number of times during sleep.
• Altered facial structure leading to double vision or unusually wide-set eyes (more likely associated with cystic fibrosis.

Risks associated with nasal polypectomy

• Infection
• Bleeding
• Voice Change
• Injury to the Brain

Nasal polypectomy in India is available at hospitals that offer world a range of medical treatments at a fraction of cost with comparable success rates and service levels. Nasal polypectomy in India is performed by skilled super specialists coupled with sound infrastructure, professional management nurses and paramedical staff to take on international competition. This is the reason because of which India has become a favorable destination for sinus treatment.

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