Indications. This operation is indicated for the ordinary mucous polypus of the nose when presenting in the post-nasal space. Polypoid masses of the ethmoid may project through the posterior cavity and are removed in the same way. A naso-pharyngeal polypus (also called choanal polypus, post-nasal polypus, or benign pharyngeal polypus) is easily removed by this procedure. Innocent tumours of the post-nasal space, such as papilloma, adenoma, fibroma, and cysts, can be removed by the same method.
Under cocaine. Cocaine and adrenalin (see [p. 572]) should be carefully applied to the septum and turbinals, as it is the passage of the instrument from the front which is often the most painful part of the proceeding. The pharynx should be lightly sprayed with a 5% solution of cocaine so as to check reflex action.
While the patient is seated in the ordinary examination chair the surgeon stands at his left hand and introduces a looped snare ([Fig. 312], [p. 613]) through the nostril most suitable for approaching the root of the growth. When the snare has reached the post-nasal space, the surgeon introduces the purified forefinger of the left hand through the mouth and up behind the soft palate, as in [Fig. 291]. Here it serves to manipulate the loop over the growth, and holds it close to the root of the pedicle while the snare is pulled home.
A few minutes should be allowed to elapse to permit the patient to recover from the unpleasant manipulation, and also to allow of coagulation of the strangulated blood-vessels. The growth should not be cut through, as it is wiser to pluck it from its attachment by a quick movement of avulsion.
The growth may come away with the snare through the nostril, or may fall into the pharynx and be expectorated.
In fairly roomy nostrils a stout polypus forceps can be used instead of the snare.
Under chloroform. In nervous subjects the same method should be carried out under a general anæsthetic, care being taken that the growth does not cause embarrassment by occluding the larynx.
Under chloroform, of course, more extensive operations can be carried out on the post-nasal space. The pedicle can be attacked with a pair of scissors with long handles, short blades, and slightly curved on the flat. These are introduced through that nostril which appears to be in most direct line with the pedicle, to act as a raspatory, and then cut through the base of the growth. In some cases an instrument such as Langenbeck’s elevator ([Fig. 338]) will prove useful if introduced through the nostril. The growth is then removed through the mouth by a twisting movement with a strong volsella.