Antrochoanal Polyp

Abstract

Antrochoanal polyp is a benign polypoid lesion orginating from the maxillary sinus antrum and extending to the choana. Our aim was to assess the clinical presentation and associated rhinological findings of antrochoanal polyp patients and to evaluate results of 2 surgical treatments termed endoscopic sinus surgery (ESS) and ESS plus mini-Caldwell operation. The study included 46 patients. Factors such as patient age, sex, history of chronic sinusitis, allergic rhinitis, septal deviations, chonca bullosa, turbinate hypertrophy, and the origin of the polyp were assessed. We also evaluated ESS and ESS plus mini-Caldwell surgical procedures for recurrences, synechia, bleeding, and ostium stenosis. Overall, there were 27 men and 19 women. The ESS approach was used in 26 cases, and 20 cases had combined ESS and mini-Caldwell procedures. The statistical significant difference between the 2 groups was only recurrence (P < 0.05). In the ESS group, bleeding, synechia, and ostium stenosis were seen more than in the ESS + mini-Caldwell group, but there was no significant difference between the 2 groups in bleeding, synechia, and ostium stenosis (P > 0.05). We thought that lower rate of recurrence found in ESS + Caldwell group in this study was associated with better visualization of the maxillary sinus walls and, therefore, easier resection of the remnant polyp. We concluded that higher incidences of bleeding and synechia were related to the mucosal damage occurring in the septum and the inferior concha due to excessive manipulation of endoscope and surgical instruments.

Antrochoanal Polyp: Updated Clinical Approach, Histology Characteristics, Diagnosis and Treatment

“…Currently, various surgical approaches are available: endoscopic sinus surgery (ESS) with polyp removal via either inferior meatus or middle meatus, or a combined inferior and middle meatal naso-antral window. Other options such as ESS with adjuvant canine fossa puncture, or ESS with "mini Caldwel-Luc" procedure aim to facilitate visualization of the anterior and inferior walls of the maxillary sinus [4,23,24].…”

“…In the ESS group, bleeding, synechia, and ostium stenosis were more evident than in the ESS plus mini-Caldwell group, but these differences were not statistically significant. Therefore, Kelles theorized that adding the mini Caldewell-Luc approach allowed better visualization of the maxillary sinus walls and subsequently easier resection of the remnant polyp [23].…”

“…Nevertheless, this approach has been largely abandoned in the treatment of maxillary sinus pathologies, because it does not address the natural ostium of the maxillary hence considered non-functional. Complications include: cheek anesthesia, sensory deficits, cheek swelling and risks for normal teeth development in children [4,23,29,33,34].…”

“…Some authors claim that different anatomic variations in the nasal cavity such as septal deviation, conchal hypertrophy, and concha bullosa may increase the intramaxillary pressure, hence predisposing for the development of ACP. While these variations were documented in up to 80% of patients with ACP, none of them were linked to increased rates of recurrence [4,17,23,24,30]. In most relevant studies, the time of recurrence was 1.2 ± 0.6 years.…”

Comprehensive review on endonasal endoscopic sinus surgery

“…The recurrence rates amount to totally 0–20% [ 674 ], [ 675 ], [ 676 ], [ 677 ], [ 678 ], [ 679 ], [ 680 ], [ 681 ], [ 682 ], [ 683 ], [ 684 ], [ 685 ]. Despite certain methodological objections regarding a comparison, the recurrence rates in cases of additional procedure via the canine fossa are constantly lower (0–8%) than in procedures exclusively via via the middle meatus.…”