ANTROCHOANAL POLYP
Susmi CM , 87
INRODUCTION
• This polyp arises from the mucosa of maxillary antrum near its accessory
ostium, comes out of it and grows in the choana and nasal cavity.
• It has 3 parts
1. Antral – thin stalk
2. Choanal – round and globular
3. Nasal – flat from side to side
AETIOLOGY
• Exact cause is unknown.
• Nasal allergy coupled with sinus infection is incriminated.
• Seen in children and young adults
• Usually single and unilateral
SYMPTOMS
• Unilateral nasal obstruction
• Bilateral nasal obstruction may occur when polyp grows into the
nasopharynx and starts obstructing the opposite choana.
• Voice may become thick and dull due to hyponasality.
• Nasal discharge mostly mucoid, may be seen on one or both sides
SIGNS
• As the antrochoanal polyp grows posteriorly, it may missed on anterior
rhinoscopy
• When large a smooth greyish mass covered with nasal discharge may be
seen.
• Soft and can be move up and down with a probe
• Large polyp may protrude from the nostril and show a pink congested look.
• Posterior rhinoscopy may reveal a globular mass filling the choana or
nasopharynx.
• Large polyp may hang down behind the soft palate and present in the oropharynx
DIFFERENTIAL DIAGNOSIS
• A blob of mucus often looks like a polyp but it would disappear on blowing the nose.
• Hypertrophied middle turbinate is differentiated by its pink appearance and hard feel of
bone on probe testing.
• Angiofibroma has history of profuse recurrent epistaxis. Firm in consistency and easily
bleeds on probing.
• Other neoplasm may be differentiated by their fleshy pink appearance, friable nature and
their tendency to bleed.
INVESTIGATIONS
• X rays of paranasal sinuses may show opacity of involved antrum.
• X ray (lateral view) soft tissue nasopharynx reveals a globular swelling in the
postnasal space.
• Noncontrast CT scan of paranasal sinuses in coronal and sagittal planes reveals
details of polyp and its extent (gold standard)
TREATMENT
• Endoscopic sinus surgery is the treatment of choice.
• Replaced earlier operations of simple polypectomy and Caldwell-Luc
operation .
• Antrochoanal polyp is removed by avulsion either through the nasal or oral
route.
• Recurrence is uncommon after complete removal.
FUNCTIONAL
ENDOSCOPIC SINUS
SURGERY
ANAESTHESIA
• General anaesthesia is preferred
• Local anaesthesia with i.v. sedation can be used in adults when
limited work is to be done.
POSITION
• Patient lies flat in supine position with head resting on a ring or head
rest. Some also prefer to raise it by 15°.
TECHNIQUES
1. Anterior to posterior (Stammberger’s technique). In this technique surgery
proceeds from uncinate process backward to sphenoid sinus. Advantage of this
technique is to tailor the extent of surgery to the extent of disease.
2. Posterior to anterior (Wigand’s technique). Surgery starts at the sphenoid sinus
and proceeds anteriorly along the base of skull and medial orbital wall. This is
mostly done in extensive polyposis
• Definitive surgical steps include:
1. Uncinectomy:
using sickle knife and removed with Blakesley forceps.
2. Identification and enlargement of maxillary ostium.
Enlarged anteriorly with a backbitting forceps.
3. Bullectomy.
Bulla ethmoidalis is penetrated with curette or Blakesley forceps and removed.
4. Penetration of basal lamella and removal of posterior ethmoid cells.
Basal lamella is dividing bony septum bw anterior and posterior ethmoid
cells.
• penetrated in the lower and medial part with curette and removed with
blakesley forceps.
• Posterior ethmoid cells are exenterated.
5. Clearance of frontal recess and frontal sinusotomy.
In the event of frontal sinus disease,frontal recess is cleared and frontal sinus drainage established.
6. Sphenoidotomy
-it is omitted if sinus is healthy.
-anterior wall of sinus is removed and pus within the sinus removed
7. Nasal packs. Finally the nasal packs are applied if septal surgery has also been done with FESS OR To
stop any bleeding from the nasal cavity
THANK YOU
