Antrochoanal polyposis: analysis of 34 cases

Abstract

An antrochoanal polyp (ACP) is a benign polypoid lesion originating from the maxillary sinus and extending to the choana. The objective of our study is to assess etiological and associated features of ACPs, and outcome following surgical treatment. Thirty-four patients who had received surgical treatment for ACPs were followed for 35 ± 17.7 months. Factors including patient age, gender, history of allergic rhinitis, chronic sinusitis, nasal septal deviation, turbinate hypertrophy, concha bullosa, accessory ostia, as well as the origin of the polyp, the surgical technique used and any recurrence, were evaluated. Overall, there were 12 females and 22 males. Mean age was 24.94 ± 8.08. Septal deviation was present in 50 %, turbinate hypertrophy in 32.3 %, concha bullosa in 17.6 %, mucous retention cyst in 32.3 %, allergic rhinitis in 44.11 %, and chronic sinusitis in 20.5 %. An accessory ostia was observed in 97.05 %. The functional endoscopic sinus surgery (FESS) approach was used in 31 cases, and three cases had combined FESS and Caldwell Luc procedures. The mean follow-up time was 35.8 ± 17.7 months. Two cases, who had been treated with FESS alone, experienced a recurrence. In conclusion, the commonest predisposing factors for ACPs are chronic inflammatory pathologies such as chronic sinusitis and allergic rhinitis. ACP left the maxillary sinus via an accessory ostium in 97.5 % of the cases. The FESS procedure is a safe and reliable method, and can be combined with the Caldwell Luc procedure when the origin of the maxillary component cannot be properly cleaned. In order to prevent recurrence, total extirpation of the maxillary component is essential.

Update on Select Benign Mesenchymal and Meningothelial Sinonasal Tract Lesions

“…3a) [55,56]. Originally thought to be increased in patients who have allergies, there is little well documented evidence for such [57].…”

“…Fluid accumulates in the lamina propria, which, along with inflammatory factors and overproduction of tissue-derived growth factors, results in polyp formation. Specifically, ACPs may be associated with mucocele or antral cyst formation in the maxillary sinus due to increased pressure in the antrum (Highmore), with pressure resulting in expansion and herniation or prolapse through an accessory or secondary ostium below the middle meatus [55,56]. These polyps frequently cross the choana (boundary between the nasal cavity and nasopharynx).…”

“…There is a male to female predilection for ACPs (2:1), while there is no gender predilection for SNIPs. ACPs tend to develop in younger patients than classical SNIPs, affecting teenagers and young adults (mean 24-28 years) [55,60]. Symptoms are non-specific, most commonly including nasal obstruction and rhinorrhea [55,[60][61][62][63].…”

Septated concha bullosa in an antrochoanal polyp patient

“…Balıkçı et al identified septum deviation in 50% and CB in 17.6% of ACP patients. 3 As for Tatlıpınar et al, they identified septum deviation in 60.86%, CB in 13.04% of the patients. 4 As for the presence of a CB with septa in an ACP patient, it has not been reported so far.…”

“…ACP may be accompanied by CB. 3,4 However, combination of septated CB and ACP has never been reported to the best of our knowledge. This paper presents a 45-year-old male patient who has a combination of septated CB and ACP.…”