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Nasal polyps in maxillary sinus
Nasal polyps in maxillary sinus Report
of a case
J. L. Esquivel, D.D.S.,* San Jo& Costa Rica SAN
JUAN
DE DIOS HOSPITAL
P
olyps in the antrum of Highmore are produced by irritation of the Schneiderian membrane, a condition known also as hyperplastic chronic sinusitis. CASE REPORT A 39-year-old white woman was referred to the Oral Surgery Clinic of the San Juan de Dios Hospital on June 11, 1958, for the surgical removal of a “hypertrophied tuberosity.” This procedure was required in order that the patient might be fitted with a full upper denture. The patient stated that the swelling had been present for 6 months. An uppr first molar had been extracted recently, and some granulation tissue was seen over the unhealed alveolus (Fig. 1). The tuberosity on the same side showed a marked expansion of the alveolar cortical plate. The opposite side did not show this peculiarity; instead, there were two premolars still in place. X-ray examination revealed a radiopaque right maxillary sinus and a break in the sinus wall communicating with the alveolus (Figs. 2 and 3). Procaine hydrochloride with epinephrine 1 :lOO,OOOwas administered, blocking the posterior superior alveolar and iufraorbital nerves with the tuberosity and infraorbital techniques, respectively. An incision was made over the crest of the ridge, extending from the posterior upper part of the tuberosity to the area of the cuspid on that side. The flap was elevated, and a thin cortical bone was removed with periosteotome and rongeurs, exposing the antrum which was filled with granulomatous tissue. These tissues or polyps were completely removed from the sinus walls by means of curettes (Fig. 4). The excess gingival tissue was trimmed off with scissors, and the edges of the wound were approximated with 3-O sutures (Fig. 5). The patient was given 250 mg. of Terramyciu every 6 hours for 3 days. The postoperative course was uneventful, with no edema or hemorrhage and hardly any pain. Pathology
report
The specimen consisted of a mass of soft tissue measuring 3 by 2.5 cm. (Fig. 6). Microscopic examination showed connective tissue surrounded by cavities of columnar *Professor and Chairman, Oral Surgery Department, University of Costa Rica School of Dentistry; Chief of the Oral Surgery Clinic, Hospital San Juan de Dios.
685
O.S., O.&I. & O.P. r\‘ovrwber, 1968
Fig. 1. Intraoral
Fig.
photograph
showing grnnulntion
tissue over unhenlcd ;~lveolns.
8
E‘ig. J
Figs. 8 and 3. Roentgenograms showing sinus wall communicating with alveolus.
right
maxillary
sinus and break
Fig.
4
Figs. 4 and 5. Operative
rndiopaque
photographs.
5
in
Nasal polyps in maxillary sinus 687
Volume 26 Number 5
Fig. 6. Surgical
specimen.
Pig. 7. Photomicrograph
pseudo&ratified epithelium. and plasma cells (Fig. 7).
showing
tissue infiltrated
with
lymphocytes
The gross mass of tissue was discretely
and plasma cells.
infiltrated
with lymphocytes
DISCUSSION
A review of the dental literature does not contribute much information concerning nasal polyps. It seemsthat this matter is of concern specifically to the rhinologist. However, since it is connected with a dental problem, it is the oral surgeon’s duty to remove these lesions, especially when, as in the present case, the hypertrophic tissue has produced enough pressure to distend the wall of the maxillary antrum, thus causing a bulging of the tuberosity and confusing the diagnosis. CONCLUSION
A case of nasal polyposis or hyperplastic chronic sinusitis has been presented. In such casesthe oral surgeon should operate on the maxillary sinus, since the condition has a direct bearing on the oral cavity. In the case reported here, histologic study revealed that the polyps were not malignant. REFERENCE
1. U. S. Naval Dental School: Company, pp. 135-136.
Color Atlas
of Pathology,
Philadelphia,
1956, J. B. Lippincott
of a case
J. L. Esquivel, D.D.S.,* San Jo& Costa Rica SAN
JUAN
DE DIOS HOSPITAL
P
olyps in the antrum of Highmore are produced by irritation of the Schneiderian membrane, a condition known also as hyperplastic chronic sinusitis. CASE REPORT A 39-year-old white woman was referred to the Oral Surgery Clinic of the San Juan de Dios Hospital on June 11, 1958, for the surgical removal of a “hypertrophied tuberosity.” This procedure was required in order that the patient might be fitted with a full upper denture. The patient stated that the swelling had been present for 6 months. An uppr first molar had been extracted recently, and some granulation tissue was seen over the unhealed alveolus (Fig. 1). The tuberosity on the same side showed a marked expansion of the alveolar cortical plate. The opposite side did not show this peculiarity; instead, there were two premolars still in place. X-ray examination revealed a radiopaque right maxillary sinus and a break in the sinus wall communicating with the alveolus (Figs. 2 and 3). Procaine hydrochloride with epinephrine 1 :lOO,OOOwas administered, blocking the posterior superior alveolar and iufraorbital nerves with the tuberosity and infraorbital techniques, respectively. An incision was made over the crest of the ridge, extending from the posterior upper part of the tuberosity to the area of the cuspid on that side. The flap was elevated, and a thin cortical bone was removed with periosteotome and rongeurs, exposing the antrum which was filled with granulomatous tissue. These tissues or polyps were completely removed from the sinus walls by means of curettes (Fig. 4). The excess gingival tissue was trimmed off with scissors, and the edges of the wound were approximated with 3-O sutures (Fig. 5). The patient was given 250 mg. of Terramyciu every 6 hours for 3 days. The postoperative course was uneventful, with no edema or hemorrhage and hardly any pain. Pathology
report
The specimen consisted of a mass of soft tissue measuring 3 by 2.5 cm. (Fig. 6). Microscopic examination showed connective tissue surrounded by cavities of columnar *Professor and Chairman, Oral Surgery Department, University of Costa Rica School of Dentistry; Chief of the Oral Surgery Clinic, Hospital San Juan de Dios.
685
O.S., O.&I. & O.P. r\‘ovrwber, 1968
Fig. 1. Intraoral
Fig.
photograph
showing grnnulntion
tissue over unhenlcd ;~lveolns.
8
E‘ig. J
Figs. 8 and 3. Roentgenograms showing sinus wall communicating with alveolus.
right
maxillary
sinus and break
Fig.
4
Figs. 4 and 5. Operative
rndiopaque
photographs.
5
in
Nasal polyps in maxillary sinus 687
Volume 26 Number 5
Fig. 6. Surgical
specimen.
Pig. 7. Photomicrograph
pseudo&ratified epithelium. and plasma cells (Fig. 7).
showing
tissue infiltrated
with
lymphocytes
The gross mass of tissue was discretely
and plasma cells.
infiltrated
with lymphocytes
DISCUSSION
A review of the dental literature does not contribute much information concerning nasal polyps. It seemsthat this matter is of concern specifically to the rhinologist. However, since it is connected with a dental problem, it is the oral surgeon’s duty to remove these lesions, especially when, as in the present case, the hypertrophic tissue has produced enough pressure to distend the wall of the maxillary antrum, thus causing a bulging of the tuberosity and confusing the diagnosis. CONCLUSION
A case of nasal polyposis or hyperplastic chronic sinusitis has been presented. In such casesthe oral surgeon should operate on the maxillary sinus, since the condition has a direct bearing on the oral cavity. In the case reported here, histologic study revealed that the polyps were not malignant. REFERENCE
1. U. S. Naval Dental School: Company, pp. 135-136.
Color Atlas
of Pathology,
Philadelphia,
1956, J. B. Lippincott