Nasal papillomas
Nasal papillomas: Excerpt from Professional Guide to Diseases (Eighth Edition)
A papilloma is a benign epithelial tissue overgrowth within the intranasal mucosa. Inverted papillomas grow into the underlying tissue, usually at the junction of the antrum and the maxillary sinus; they generally occur singly but sometimes are associated with squamous cell cancer. Exophytic papillomas, which also tend to occur singly, arise from epithelial tissue, commonly on the surface of the nasal septum.
Causes and incidence
A papilloma may arise as a benign precursor of a neoplasm or as a response to tissue injury or viral infection, but its cause is unknown. Both types of papillomas are most prevalent in males. Recurrence is common, even after surgical excision.
Signs and symptoms
Both inverted and exophytic papillomas typically produce symptoms related to unilateral nasal obstruction — congestion, postnasal drip, headache, shortness of breath, dyspnea and, rarely, severe respiratory distress, nasal drainage, and infection. Epistaxis is most likely to occur with exophytic papillomas. Occasionally hemorrhage may be the presenting symptom.
Diagnosis
On examination of the nasal mucosa, inverted papillomas usually appear large, bulky, highly vascular, and edematous; color varies from dark red to gray; and consistency, from firm to friable. Exophytic papillomas are usually raised, firm, and rubbery; pink to gray; and securely attached by a broad or pedunculated base to the mucous membrane.
PEDIATRIC TIP Juvenile angiofibroma is a benign vascular tumor that arises in the nasopharynx and occurs most commonly in adolescent males. Nasal obstruction and hemorrhage may occur as with nasal papillomas. Any adolescent male who continues to have recurrent episodes of epistaxis should be assessed for juvenile angiofibroma. Medical management involves surgical excision, with preoperative embolization to reduce bleeding.
CONFIRMING DIAGNOSIS Tissue biopsy followed by histologic examination of excised tissue confirms the diagnosis.
Treatment
The most effective treatment is wide surgical excision or diathermy, with careful inspection of adjacent tissues and sinuses to rule out extension. The use of surgical lasers is becoming more popular. Ibuprofen or acetaminophen and decongestants may relieve symptoms.
Special considerations
❑ If bleeding occurs, have the patient sit upright, and instruct him to expectorate blood into an emesis basin. Compress both sides of his nose against the septum for 10 to 15 minutes, and apply ice compresses to the nose. If the bleeding doesn’t stop, notify the physician.
❑ Check for airway obstruction. Place your hand under the patient’s nostrils to assess air exchange, and watch for signs of mild shortness of breath.
❑ If surgery is scheduled, tell the patient what to expect postoperatively. Instruct him not to blow his nose. (Packing is usually removed 12 to 24 hours after surgery.)
❑ Postoperatively, monitor vital signs and respiratory status. Use pulse oximetry to monitor oxygen saturation levels. As needed, administer analgesics and facilitate breathing with a cool-mist vaporizer. Provide mouth care.
❑ Frequently change the mustache dressing or drip pad, to ensure proper absorption of drainage. Record the type and amount of drainage. While the nasal packing is in place, expect scant, usually bright red, clotted drainage. Remember that the amount of drainage typically increases for a few hours after the packing is removed.
❑ Because papillomas tend to recur, tell the patient to seek medical attention at the first sign of nasal discomfort, discharge, or congestion that doesn’t subside with conservative treatment.
❑ Encourage regular follow-up visits to detect early signs of recurrence.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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