The diagnosis of sinochoanal polyp (SP) with the origin of either maxillary or ethmoidal sinuses may not be uncommon for any otorhinolaryngologist. We report two rare cases of large sphenochoanal polyp (SCP) that underwent complete excision using endoscopic transnasal approach, debulking with microdebrider, and subsequent evacuation of polyp through the oral cavity under image-guided surgery (IGS) protocol. Due to the rarity of SCP, this condition may sometimes be mistaken for antrochoanal polyp (ACP) and lead to unwarranted exploration of other sinuses and incomplete removal of SCP from the sphenoid sinus. In this report, we also discuss on the diagnostic confusion with ACP, the surgical approach, as well as the usage of endoscopic and imaging techniques in managing SCP.
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