Hairy polyp of the pharynx obscured on physical examination by endotracheal tube, but diagnosed on brain imaging

Large Nasopharyngeal Hairy Polyp Causing Immediate Respiratory Distress at Birth

This article presents a rare case of a large hairy polyp, a developmental malformation causing a benign tumor, within the nasopharynx. The patient, born with the polyp obstructing the airway, required immediate intubation and a combined transnasal-transoral surgical approach for excision. The case underscores the challenges in diagnosing and managing such polyps, emphasizing the importance of imaging for surgical planning, and the consideration of multiple approaches to ensure complete resection and prevent recurrence. Laryngoscope, 2024.

CT and MRI Features of Hairy Polyps in Neonates and Infants: A Retrospective Study of 14 Patients

Background: The typical imaging findings of hairy polyps have been described mostly in case reports. This study was conducted to describe the CT and MRI features of hairy polyps and their common associated abnormalities. Methods: Medical records of 14 patients with pathological diagnosis of hairy polyps were collected for this study. For each patient, the medical records, including demographics, clinical manifestations, and imaging findings were reviewed. Results: The female-to-male ratio was 3.7:1. The age at first episode varied from birth to 2.7 years. The masses were derived from the back side of the soft palate in seven (50.0%) cases, from the lateral pharyngeal wall in four (28.6%) cases, from the soft palate in one (7.1%) case, from the nasal vestibule in one (7.1%) case, and from the parapharyngeal space in one (7.1%) case. A total of 11 (78.6%) cases presented with pedicled masses containing fat and a central core of soft tissue, there were 3 (21.4%) cases whose imaging findings were atypical, and there were 6 (42.9%) patients who had other pathologies. Conclusions: Hairy polyps typically presented as pedicled masses containing fat and a central core of soft tissue, but sometimes their imaging findings can be atypical and they can be associated with other congenital abnormalities. CT and MRI are reliable methods for the diagnosis of hairy polyps and their associated abnormalities.

Imaging features of pharyngeal hairy polyps in infants

BACKGROUND

Hairy polyps are the most common congenital deformity of the oral-nasopharynx/oral cavity in infants, which may lead to severe complications in the newborns. However, few studies have been published with respect to their radiological features, and most are case reports.

OBJECTIVE

This study aimed to analyze radiological features of the oral‑nasopharyngeal hairy polyps and to identify the radiological features with the highest diagnostic value.

MATERIALS AND METHODS

From 2014 to 2019, pediatric cases pathologically diagnosed as hairy polyps and having received radiological examination at the Children's Hospital Affiliated to Zhejiang University were retrospectively analyzed. Radiological evaluations were conducted on tumor size, location, morphology, density or signal features as well as the enhancement pattern.

RESULTS

A total of six infants were recruited. Clinical features observed in these cases included choking on milk with cyanosis, intermittent dyspnea, oropharyngeal mass, and snoring. Lesions were derived from the left tubal torus in three out of six cases, from the left lateral aspect of soft palate in one, from the left lateral pharyngeal wall in one, and from the right tubal torus in one. They were shown as pedicled polyp-like well-circumscribed mass with fat density or signal as well as a stalk on CT or MRI. In the contrast-enhanced scan, the fat components were not enhanced, while the stalk was mildly enhanced.

CONCLUSION

Hairy polyps had typical radiological features. Hairy polyps should be considered for pedicled polyp-like well-circumscribed mass in the oral-nasopharynx of infants with fat density or signal as well as a stalk.

Pharyngeal hairy polyps: Case series and literature review

It was aimed to report 5 cases of pharyngeal hairy polyps, and to summarize the characteristics combined with literature review.Five cases with pathological diagnosis of pharyngeal hair polyps were diagnosed and treated in our department from June, 2006 to October, 2016, and retrospective analysis of their clinical data was performed. Among the 5 cases, there were 1 male and 4 female, with the age of 2 days to 26 months old. After birth, these patients were accompanied by stridor, difficulty breathing, snoring, feeding difficulties, and slow weight gain.Gray mass in the stem original from the pharynx was found in all 5 cases, with the surface hair-covering. The polyp resections were performed under general anesthesia, with the complete removal of polyp along the pars basilaris during surgery smoothly. The operation during was 5 to 20 minute, with an average of 12 minute, and there was little hemorrhage during operation. Symptoms disappeared completely after the surgery, and follow-up was performed for 1 year without recurrence shown.Pharyngeal hairy polyp is a rare non-malignant clinical disease, mainly caused by symptoms in respiratory tract obstruction. Complete removal of polyps along the pars basilaris is an effective treatment, with no recurrence case reported after surgery.

Severe respiratory distress at birth caused by a hairy polyp of the Eustachian tube: Transoral endoscopy-guided treatment

Hairy polyps are rare developmental lesions, which present as masses mainly consisting of fatty tissue covered by skin, seldom localized in the nasopharynx, causing respiratory obstruction. We describe the case of a female newborn affected by a hairy polyp arising from the left Eustachian tube, who presented severe respiratory distress soon after birth. The polyp was successfully removed transorally under videoendoscopic guidance. This case highlights the importance of including hairy polyp in the differential diagnosis of respiratory distress at birth because this type of tumor can be lethal and requires prompt treatment. A transoral endoscopy-guided approach can allow successful and minimally invasive excision even in a newborn.

Hairy Polyp of the Nasopharynx Arising from the Eustachian Tube

Hairy polyps of the nasopharynx display characteristic radiological imaging findings, including the presence of fat in the polypoid mass. Furthermore, diagnostic imaging is useful for delineating the site of origin of these lesions, which can facilitate surgical planning. For instance hairy polyps that arise from the right Eustachian tube can be amputated via a trans-nasal approach with endoscopy, but may necessitate a two stage approach in order to avoid injury to critical structures, such as the internal carotid artery. On histology, hairy polyps comprise an outer keratinizing squamous epithelium with adnexal tissue, including hair follicles, and central fibroadipose and cartilaginous tissue. These features are exemplified in this sine qua non radiology-pathology correlation article.

Hemorrhagic Hairy Polyp Causing Velopharyngeal Dysfunction in a Newborn

Velopharyngeal dysfunction (VPD) can be secondary to anatomic, neurologic, or functional maldevelopment in the pediatric population. We present a case of transient VPD after the removal of a voluminous oropharyngeal hairy polyp in a newborn with an intact palate. This report sensitizes physicians, speech-language pathologists, and occupational therapists not only to the repercussions of oropharyngeal congenital masses, such as hairy polyps, on the feeding mechanisms of a newborn but also to the possibility of conservative management.

Naso-oropharyngeal choristoma (hairy polyps): an overview and current update on presentation, management, origin and related controversies

This review presents a comprehensive and updated overview of bigerminal choristomas (hairy polyps) of naso-oropharynx/oral cavity, and discusses the controversies related to nosology and origin from a clinico-embryologic perspective. English-language texts of the last 25 years (January 1989-January 2014) were collected from the PubMed/MEDLINE database using the given keywords. Of the 330 records, 64 full-text articles (mostly case reports/series) were selected, incorporating clinical data from 78 patients, after screening through duplicates and the given exclusion criteria. With the available evidence, hairy polyps appear more common than generally believed, and are increasingly being recognized as an important, often-missed cause of respiratory distress and feeding difficulty in neonates and infants. Such a child without any apparent cause should be examined with flexible nasopharyngoscope to specifically look for hairy polyps which might be life-threatening, especially when small. The female preponderance as believed today has been found to be an overestimation in this review. These lesions are characteristically composed of mature ectodermal and mesodermal tissue derivatives presenting as heterotopic masses, hence termed choristoma. However, little is known about their origin, and whether they are developmental malformations or primitive teratomas is debatable. Involvement of Eustachian tube and tonsils as predominant subsites and the speculated molecular embryogenesis link hairy polyps to the development of the first and second pharyngeal arches. They are exceptionally rare in adults, but form a distinct entity in this age-group and could be explained as delayed pluripotent cell morphogenesis or focal neoplastic malformations, keeping with the present-day understandings of the expanded "teratoma family".

Cleft Palate Associated with Hairy Polyp: A Case Report

Congenital tumors of the oral cavity are extremely uncommon, and hairy polyps are rare nonneoplastic growths. Most hairy polyps arise from the oronasopharynx and may cause impairment of the upper aerodigestive tract in newborns. Cleft palate is one of the most common congenital anomalies but its association with hairy polyp has been rarely reported. We report a case of hairy polyp with cleft palate and its management.

Congenital hairy polyp of the palatopharyngeus muscle

Purpose. To describe clinical, radiologic, and histological features of a congenital hairy polyp arising from the palatopharyngeus muscle in a neonate. Methods. Chart of a 2-day-old female referred to a tertiary care pediatric hospital for assessment of intraoral mass was reviewed. Results. The child was born at 32 weeks and an intraoral mass was noted. The patient was transferred to tertiary care children's hospital on day 2 of life. The child had increased work of breathing at presentation and required continuous positive airway pressure. Physical examination revealed a pedunculated mass which was protruding into the oropharynx from the nasopharynx. MRI of the lesion documented a discrete bilobed mass which filled the posterior nasopharynx. The mass abutted the uvula and soft palate; however, the mass did not appear to be arising from the soft palate. Intraoperative exam showed a mass arising from the right palatopharyngeus muscle in the superior pole region of the tonsil. Histologic examination showed ectodermal and mesodermal derivatives confirming congenital hairy polyp. At 8-month followup, the surgical site was healed with no evidence of recurrent lesion. Conclusions. Congenital hairy polyp, though uncommon, should be considered in the differential diagnosis of oropharyngeal mass in neonates.

Hairy polyp can be lethal even when small in size

A case of sudden cardiopulmonary arrest in a 3-month-old girl is presented. The patient had barely recovered from hypoxic encephalopathy when she presented with repeated respiratory distress. Computed tomography and endoscopic analysis revealed a shiny polyp in the lateral wall of the nasopharynx, and this polyp was suspected to be the main cause of respiratory distress. After referral to our hospital, surgical removal was performed, and the histopathological diagnosis was hairy polyp. Hairy polyp is a rare congenital benign tumor that sometimes induces respiratory distress. This polyp can potentially induce a life-threatening event. In a systematic review of 40 reported cases, polyps of ≤ 3.0 cm in diameter have a higher risk of respiratory distress than do those >3.0 cm in diameter (P = 0.01). Small hairy polyps may be lethal because of delayed diagnosis. To locate small hairy polyps, physicians should not hesitate to perform further examination because there is the possibility of oversight with only physical examination.

Pharyngeal hairy polyps: five new cases and review of the literature

Pharyngeal hairy polyps are rare lesions that present as a pedunculated mass that may arise from the oropharyngeal or nasopharyngeal regions of the pharynx. The mass has the potential to partially or completely obstruct pathways towards the trachea and/or esophagus resulting in respiratory distress and/or feeding difficulties respectively. They have a predilection for female infants of 6:1 with the vast majority of the cases occurring in the infantile period. We report 5 cases of the hairy polyp in female infants, one of which showed unusual presentation since it was diagnosed at ten months of age.

Congenital hairy polyp of the soft palate

Hairy polyp is an unusual developmental malformation that is most frequently seen as a pedunculated tumor in the neonate. They are benign lesions containing elements of both ectodermal and mesodermal origin. The symptoms of hairy polyps relate both to their location and their size. Larger lesions produce symptoms due to feeding difficulties and airway obstruction while smaller lesions cause intermittent symptoms resulting from a ball-valve type of obstruction. We present two cases of a soft palate hairy polyp causing respiratory and feeding difficulties and review the literature.

US and MRI of a pharyngeal hairy polyp with pathological correlation

Hairy polyps are uncommon developmental malformations of the oropharynx. They are frequently pedunculated and can cause respiratory distress in the neonate. Hairy polyps are usually diagnosed with MRI but can be well seen at US. To our knowledge, the sonographic features have not been previously reported.

Unusual case of soft palate hairy polyp causing airway obstruction and review of the literature

Hairy polyps are rare benign tumors that are derived from 2 germ layers: ectoderm and mesoderm. Although location in the head and neck area is rare, the soft palate as the site of origin is even more unusual. The clinical presentation depends on the polyp's location and size. These masses can commonly cause respiratory and feeding difficulties. We present a case of a soft palate hairy polyp causing respiratory and feeding difficulties in a 6-month-old female infant and review the literature.

Two unusual cases of pharyngeal hairy polyp causing intermittent neonatal airway obstruction

Hairy polyp of the pharynx is an uncommon developmental malformation that is most frequently seen as a penduculated tumour in the neonate. The clinical presentation is characterized by the presence of a polypoid mass protruding through the mouth as 'a second tongue' causing respiratory distress. Two patients are presented with this condition.