It was formerly supposed that develop ment of mucous polypi was primary, and suppuration of the ethmoidal, as well of the maxillary sinus, secondary to these growths, the explanation being that the presence of polypi either produced an aggravated rhinitis or else mechanically closed the nasal openings into the max illary sinus and the ethmoidal cells and thus produced a suppurating inflamma tion. It is generally felt, however, that the reverse is true, and that mucous polypi are of inflammatory origin and the result of a chronic middle turbinal rhinitis and ethmoidal disease. The character of this ethmoidal disease is, as a rule, simple in its commencement; but, as the result of enlargement of the middle turbinated and of the develop ment of this cedematous granulation tissue, or of polypi, suppuration usually occurs later.
Nasal polypi are not myxcedematous growths, but, pendent tissue in the nose, which bas assumed that shape because of the effusion of serum into it from the blood-vessels. While in the fluid of a polyp there is SOIlle mucin derived from glandular structure the polyp may con tain, and here and there by careful focus ing an occasional embryonal new con nective-tissue cell may be seen, there is little or no new formation of tissue, but on the contrary a separation of the fibres of the pre-existing subepithelial stroma by serous effusion. Jonathan Wright (Med. Record, Jan. 26, 1901).
Pedunculated polypi and the condi tion of thickening on the anterior face of the middle turbinated formerly termed "sessile polypi" are histologically identical, differing only in their cedema tous quality. Polypi occur much more frequently in men than in women and are rarely seen in patients under the twentieth year.
Treatment.The old method of op erating by traction with forceps is no longer in vogue. The removal can be much more easily and thoroughly ef fected by means of the cold wire-snare. A 5-per-cent. solution of cocaine is suffi cient to relieve pain and to reduce con gestion and swelling so that the polypi may be easily seen, grasped, and re moved. Very little bleeding follows their removal, but it is better to tighten the cold snare slowly in order that thc polypi may be removed at their attach ment. Three or four operations are sufficient to clear both nasal passag,es. The thickened tissue covering the mid dle turbinated bone can be excised with nasal scissors and removed with the cutting-forceps.
After the polypi have been taken away the nasal passages should be irri gated at least twice a day with proper disinfectants used with a post-nasal syringe. The patient should visit his physician at least once a month in order to ascertain if there is any attempt at regrowth, and that it may be prevented by the application of the galvanocautery to the cicatrix. After careful cauteriza tion there is often no dispositiou toward regrowth. In removing polypi as little
as possible of the normal structures of the nose should be sacrificed in order to prevent the development of chronic purulent rhinitis.
In considering the prognosis in cases of mucous polypi, it should be remem bered that these growths are inflamma tory swellings resulting from a middle turbinated and ethmoidal inflammation. After they have been entirely removed, therefore, there remains enlargement of the middle turbinated bone itself, and extensive tissue thickening on the an terior, posterior, and the internal face of the middle turbinated. The portion wedged in between the middle turbi nated and the septum may require re duction or complete removal. A portion of the middle turbinated bone itself 1611 perhaps require to be taken away, in order to obtain nasal respiration and drainage and to reach the seat of sup puration in the anterior ethmoidal cells and to relieve the painful symptoms which accompany a suppurating eth moiditis. While it is safe to promise the quick removal of mucous polypi, it should be remembered that the patient is frequently left with a chronic rhinitiA not easily corrected.
Miscellaneous Tumors. Ft Bumf:vv.., originating in the anterior nasal cavities proper are exceedingly rare. Indeed, it is probable that the majority of casvs reported as such were mistaken for other growths. Removal with the wire snare is the only measure indicated.
PA l' I 0 T A . TheSC rt growths are somewhat less rare than the former neoplasms. They are usually situated in the anterior portion of the ?-:- ..r a.1, or on the floor of the ' t . rh, V may grow sufficiently t., ...I st obstruition and bleed easily. F \ are nadilv removed with the snare.
\-,s. Thcse grow ths are occasion :4;N n t ith in the nasal cavities at the r.,-r of the middle turbinated 1. :,e. Th(v usually contain yellow, vis , quid. They cause obstruction and ,...ina.t.nics quite severe pain, and are a=sociated with mucous polypi, .in Ns-hid' they differ by their hard ', -=. Thiv may either be perforated by n tans of the burr or trephine, or cut off w ith rongtur forceps or a strong wire snare.
Call no longer be con s.dirLd as rare. judging from the num bur of cases reported. Repeated epis taxis. increasing obstruction and pain at the brow, sometimes radiating to the ample. are the most prominent symp toms. The growth being usually located in the upper part of the nasal cavity in N.Aved, orbital pressure may occur, ex ,plithalmos, widening of the bridge of tile nose, etc., being occasionally pro duced.
When the growth can be reached, re ii_Jval with the snare and subsequent e zretting are sornethnes possible. But often the location of the tumor is such a, to expose the patient to meningitis, even if simpler measures such as cauter ization by chemicals or the cautery are tried.