INCIDENCE OF NON-MALIGNANT LESIONS OF NOSE AND PARA NASAL SINUSES IN A TERTIARY CARE HOSPITAL.

Palaniappan S. and V. Annamalai ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 09 January 2018 Final Accepted: 11 February 2019 Published: March 2019 Aim: To analyze the clinical presentation, incidence, sexual distribution and management update of non malignant lesions of nose and para nasal sinuses. Materials and Methods: This is a prospective study between the time period 2017 to 2018 in a tertiary care hospital with total number of 280 patients .Age and sex distribution along with clinical presentation of benign lesions of nose and paranasal sinuses were studied. Clinical presentations with prior general examination along with ENT evaluation was done. Investigations , medical and surgical management with follow up carried out by the same surgeon. Results were analysed statistically. Results: Age prevalence for the benign lesions were more predominant in the younger age group (11-30 years). Males were more predominant than females. Incidence of nasal polyp was 35.71%, benign tumours 22.4%. Nasal obstruction (62.5%), nasal discharge(42.5%), nasal mass (42.5%) were the commonest clinical presentations.

Histology :-Linning epithelium: Pseudostratified ciliated columnar epithelium.Submucosa contains goblets cells and Minor salivary glands. SURGICAL IMPORTANCE: Since the entire respiratory tract is lined by the same type of epithelium diseases from the anterior nares may affect para nasal sinuses and bronchial segment .VENOUS DRAINAGE : Provided by-opthalmic, facial vein and pterygoid and pharyngeal plexuses. Surgical importance: intra cranial connection is important because facial infection can drain via these vein to the cavernous sinus .NERVE SUPPLY -Senosry: 5 th CN -opthalmic and maxillary division, Special sensory: olfactory nerve ANS It provides secretomotor and vasomotor control.Sympathetic fibres: From the first 5 thoracic spinal segments Post ganglionic fibres run with sphenopalatine vessles. Surgical importance Increased tone vasoconstriction, decreased nasal secretion.

Methodology:-
Aim of this study is to analyse the clinical presentation, incidence and sexual distribution along with management update of non malignant lesions of nose and para nasal sinuses. It is a prospective cohort study conducted in a tertiary care hospital. Total number of patients in the study was 280 between the time period of 2017 to 2018. Initial history elicitation was done using a pre charted proforma. It included name, age, sex, occupation, duration of hospital stay. Previous history regarding nasal obstruction, nasal discharge, epistaxis, anosmia, headache, facial pain, frequent cold, epiphora, nasal mass, occular symptoms was elicited. Anyother comorbidities like Diabetes, Hypertension, Asthma, Tuberculosis were looked for. Treatment history and relevant personal history was checked.
General examination of CVS, RS, CNS, abdomen was done. Patients were examined for anaemia, clubbing, jaundice and pallor of soft palate.
ENT examination regarding face, nose, throat and ear were done.
Nose:-External contour like widening of nasal bridge, saddling of nasal dorsum,columella. Anterior rhinoscopy was done to describe the lesion and also septum, floor, lateral wall of the nose was examined. Posterior rhinoscopy was done to look for the mass, post nasal drip, choanal orifice and eustachian tube orifice.
Throat:-Throat was examined for post nasal drip, granular pharyngitis, gingivolabial sulcus, alveolus, palate and dental formula Ear:-Ear examination was done to rule out tympanic membrane retraction, perforation, cholesteatoma and masses.
Investigations:-Urine routine, complete haemogram, Randam blood sugar, Renal function test, liver function tests and coagulation profiles were done.
Blood grouping and typing, VDRL, HbsAg, HIV were done Imaging:-X-Ray of paranasal sinuses, Skull, Chest PA view, Orthomopantogram was done. Computed Tomogragphy of nose and para nasal sinuses were done. Axial, coronal and sagittal sections were analysed.
Magnetic Resonance Imaging of nose and para nasal sinuses were done.
Angiogram and digital subtraction angiography was done.
Culture sensitivity was done to detect bacterial infections, KOH smear was taken and sent for fungal study. Sputum AFB and blood culture was done to rule out tuberculosis.
Pathology of the masses was determined with help of Fine needle aspiration cytology and histopathological examination.
Surgical treatment included functional endoscopic sinus surgery and excision biopsy of the mass.
Patients were followed up for 6 months in regular intervals and telephonic follow up was also done.

Results:-
In this study 280 patients of non malignant lesions of nose and para nasal sinuses were analysed in the following order:

Non Malignant Lesions Studied-Disease Incidence
In the total number of 280 patients included in the study, 100 presented with nasal polypi constituting 35.71%. Granulomas were reported in 52 patients constituting 18.57%. Benign tumours accounting for 22.14% seen in 62 patients. Cystic swellings were seen in 50 patients with incidence of 17.9 %. Remaining 16 patients had miscellaneous tumours making it as 5.71%. Age Incidence:-Age incidence of our series tallies with that of the literature. Representation of age incidence among the study group has been shown in Table 1 Sex Incidence Sex incidence in the series is shown in the Table 2. Dominant age group was 11 to 30 years constituting the 66.09% of the study population. Males were more predominant than females for benign lesions of the nose and para nasal sinuses.
Clinical presentation of the nose and para nasal sinuses.Graph 1.0   ii.Bone tumors(13 cases)

Conclusion:-
Nasal polypi and benign tumours were found to be predominant lesions in the Non malignant lesions of the nose and para nasal sinuses in this study. Nasal polypi 35.71%, Benign tumours 22.4%. Non malignant lesions of nose and para nasal sinuses were prevalent in Younger age group (11 to 30 years) 66.09%.
The lesions were predominant in males compared to females. Predominant clinical presentations were nasal obstruction, nasal discharge, nasal mass, epistaxis.
Clinical features, Investigations like X-ray of para nasal sinuses, CT of paranasal sinuses, Pathological investigations such as fine needle aspiration cytology and histopathological examination were used more in our study for the management of non malignant lesions of nose and para nasal sinuses.
Histopathological evaluation played a major role in diagnostic and therapeutic evaluation.
In the management of non malignant lesions and para nasal sinuses Functional Endoscopic Sinus Surgery played an important role.