Overview of Nasal Masses In children

Abstract

Background: Nasal masses in children are rare but can cause much diagnostic uncertainty. Presentation varies with age and cause (1). And the approach to management of these masses will be varying according to the diagnosis.
Aim: to reveal the clinicopathological profile of nasal masses in children seen during the study period and to draw attention to the most important findings and results of this study.
Patients and Methods: A prospective descriptive study of 20 selected pediatric patients with nasal mass seen in ENT department at Al-kadhimain teaching hospital and ENT center in Al- Sulaimaniyah teaching hospital over a period of 12 months (Feb.2014-Mar.2015).
The age of studied group ranging from birth to fifteen years according to definition of Iraqi law to childhood(2, 3).
Direct questioning of patients and/or his parents about the biographic data, chief compliant and duration, other medical or surgical history, drug history and any relevant socio-economic history (attached questionnaire).
Preoperative examinations of the patients were done clinically, radiologically in otorhinolaryngology department at Al-kadhimain teaching hospital and E.N.T. center in Sulaimaniya teaching hospital,Radiological examination includes CT scan of nose and paranasal sinuses for all 20 children in studied group and the MRI done for two patients in addition to CT scan.After reaching the diagnosis, 18 patients underwent different sorts of surgical interventions and all the masses were excised and have been sent for histopathological study to confirm the diagnosis, the other 2 patients were referred to other specialty.Follow up period was for 6 months and depend mainly on history and clinical examination with rigid and fibreoptic nasoendoscope, all of them were normal.All data then analyzed using SPSS (version 21) computer program.
Results: the collected data were analyzed and the results are: The age of 70% of the patient was above 7 years, 60% of patients were males and 40% was females, Seventy five percent complained from nasal obstruction, 15% complained from nasal discharge, and only 10% complained from epistaxis. The duration of disease before presentation was 0 to 119 days in 45% of patients, 120 to 239 days in 30% of patients, 240 to 359 in 15% of patients, and 360 days and above in 10% of patients, The most common associated symptoms were obstruction and discharge in 50% of patients, followed by obstruction and periorbital swelling in 20% of patients. Twenty percent of patients had not history of associated signs or symptoms, the most common histopathological findings were antrochoanal polyp in 35% of patients and fungal rhinosinusitis in 35% of patients, and rhinolith in 10%, rhabdomyosarcoma in 5%, chondroma in 5%, hemangioma in 5%, meningocele in 5%.
The modalities of treatment used in this study were: Endoscopic surgery was used in 80% of patients, external or endonasal approach in 10% of patients, and only 10% of patients were referred to other specialty.
CT changes which include bony changes in 60% of the cases, opacity was unilateral in 85% of the cases, 15% was bilateral; the opacity was homogeneous in 35% and heterogeneous in 65% of the cases.
The highest mean age was 10.2 + 3.1 years and 10.1 + 2.7 years in patients of antrochoanal polyp and patients of fungal rhinosinusitis, respectively. The lowest mean age was 6 + 0.0 years in patients of meningocele, the difference was statistically significant (P< 0.05).
Most of males and females complained from antrochoanal polyp (41.7% and 25.0%, respectively) and fungal rhinosinusitis (33.3% and 37.5%, respectively). The relationship between gender and histopathological diagnosis was statistically not significant, P> 0.05.
Conclusion: Nasal masses in children are rare but can cause much diagnostic uncertainty. The clinicopathological profile of nasal mass in children was revealed, Presentation varies with age and cause, and the management is according to the diagnosis.