ABSTRACT
Background: Antrochoanal polyps (ACPs) are benign polypoidal mass originating from the maxillary sinus and they extend into the choana. The etiopathogenesis of ACP is not clear. These are found more commonly in children and young adults. ACP is almost always unilateral and common symptoms include nasal obstruction and nasal discharge. These lesions are extremely rare in the older adult age group. Materials and Methods: This is a retrospective study of 14 cases of ACPs managed between June 2017 and July 2022. Detailed clinical presentations, investigations, and treatment with surgical interventions for ACPs were studied. Results: Out of 14 cases of older adult patients with ACPs, there are 8 (57.14%) cases with a polyp on the left side and 6 (42.85%) cases on the right side of the nasal cavity. The most common symptom was constant and unilateral nasal obstruction in 12 (85.71%) patients, followed by purulent nasal discharge in 7 (50%) cases, clear rhinorrhea in 5 (35.71%) cases, facial pain in 4 (28.57%) cases, snoring in 3 (21.42%) cases, sneezing in 3 (21.42%) cases, and halitosis in 2 (14.28%) cases. Conclusion: ACPs are uncommon in the older adult age group. Diagnostic nasal endoscopy and computed tomography scans are important tools for the diagnosis of ACP. Functional endoscopic sinus surgery and power instrumentation are helpful for the complete removal of ACPs and are considered extremely safe procedures. Clinicians and otolaryngologists are often not aware of the prevalence of ACPs among the older adult age group.
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Abstract Introduction There are no definitive parameters to guide the etiology and severity of pediatric antrochoanal polyps. Objective The aim of our study is to compare the values of blood cell distribution parameters in cases of pediatric antrochoanal polyps (ACPs) with those of the control group. These values may be guiding parameters in determining the etiology of ACPs and evaluating the severity of the disease and the risk of recurrence. Methods Blood count values of patients operated for pediatric ACPs were retrospectively analyzed and compared with the data of the control group with the same age and gender distribution. The ACPs group was divided into subgroups in terms of inflammation, severity, and recurrence, and these subgroups were statistically compared as well. Results When the ACP patient group and the control group were compared, there was no statistically significant difference between the two groups. When we compared the patients considering the CT findings, there was a statistically significant difference between the stage III patients and the control group in terms of mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR) values (p < 0.05 in both). Similarly, the MPV and PLR values were significantly higher in the recurrence patient group than in the control group. (p < 0.05 in both). Conclusion As a result of the data obtained, it can be suggested that inflammatory parameters in pediatric cases of ACPs vary in terms of recurrence and the severity of the disease.
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Fibromyxomas are uncommon, tenaciously infiltrative neoplasms that infrequently appear in the facial bones and paranasal sinuses. The neoplasms are slow growing and result in expansion of the surrounding bony cortices. In the present study, we report an extremely rare case of antrochoanal fibromyxoma that occluded the ostiomeatal complex and originated from the maxillary sinus inferior wall. Initially, the neoplasm was suspected to be a nasal polyp. However, after endoscopic sinus surgery, the neoplasm was diagnosed as fibromyxoma based on histopathology.
Subject(s)
Facial Bones , Fibroma , Maxillary Sinus , Nasal Polyps , Paranasal Sinuses , PolypsABSTRACT
BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is defned as a polyp that originates in the maxillary sinus. The polyps are usually seen in children and adolescents. The aim of this study was to compare the characteristics between the child and adults groups who have ACP. SUBJECTS AND METHOD: A total of 55 patients who underwent endoscopic sinus surgery for ACP was enrolled in this study. The population of this study was divided into child (≤17 years old) and adult (≥18 years old) groups. The clinical data and CT fndings including stages, maxillary sinus retention cyst (MSRC) of non-ACP lesion side, and accompanying sinusitis using Lund-Mackay score were retrospectively investigated. RESULTS: On CT stage of ACPs and MSRC, there were no signifcant differences between the two groups (p > 0.05). The accompanying sinusitis was more common in child group (p < 0.05). Endoscopic sinus surgery (ESS) combined canine fossa approach as well as ESS alone were the effective methods in treating ACPs in both groups. CONCLUSION: The accompanying sinusitis could be common in children with ACPs, which should be treated with ACPs simultaneously.
Subject(s)
Adolescent , Adult , Child , Humans , Maxillary Sinus , Methods , Polyps , Retrospective Studies , SinusitisABSTRACT
Antrochoanal polyp is a benign lesion, usually arising from the maxillary sinus extending posteriorly into the nasopharynx. Typically it presents as a unilateral nasal obstruction with mucopus rhinorrhea, sleep disturbance, postnasal drip, and mouth breathers. Epistaxis is an extremely rare complaint. Unilateral nasal mass presenting in a teenage boy will increase the suspicion of juvenile nasoangiofibroma. We report a teenage with extensive unilateral nasal mass with such presentation, which later turned out to be antrochoanal polyp.
ABSTRACT
Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. They occur more commonly in children and young adults, and they are almost always unilateral. The etiopathogenesis of ACPs is not clear. Nasal obstruction and nasal drainage are the most common presenting symptoms. The differential diagnosis should include the causes of unilateral nasal obstruction. Nasal endoscopy and computed tomography scans are the main diagnostic techniques, and the treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS for complete removal of ACPs are extremely safe and effective procedures. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence.
Subject(s)
Child , Humans , Young Adult , Diagnosis, Differential , Drainage , Endoscopy , Maxillary Sinus , Nasal Obstruction , Polyps , RecurrenceABSTRACT
BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through the sinus ostium, and extends into the choana. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc operation, osteoplastic maxillary sinus operation, and endonasal endoscopic removal. In this study, we evaluated the clinical presentation of ACP and compared its surgical outcomes. MATERIALS AND METHODS: We retrospectively reviewed 111 patients who were treated for ACP between January 1995 and May 2008, and analyzed clinical features, radiologic findings, and surgical results. RESULTS: The study group consisted of 111 patients (65 males, 46 females) with a mean age of 20.0 years (range, 4 to 70). Sixty-one cases were accompanied by sinusitis (20 with unilateral sinusitis, 41 with bilateral sinusitis). Endoscopic sinus surgery (ESS) was used to treat 95 cases, and the external approaches of Caldwell-Luc operation or osteoplastic maxillary sinus operation were applied in 12 and four cases, respectively. Among those who received ESS, ACP recurred in 16 cases, whereas none of the patients who received the external approach showed recurrence. CONCLUSION: Endoscopic sinus surgery is a good alternative method for the treatment of ACP. If the antral part of ACP cannot be removed completely, an external approach such as Caldwell-Luc operation or osteoplastic maxillary sinus operation for pediatric patients may be considered to prevent recurrence.
Subject(s)
Humans , Male , Carbamates , Maxillary Sinus , Mucous Membrane , Organometallic Compounds , Polyps , Recurrence , Retrospective Studies , SinusitisABSTRACT
Fungal ball is an extramucosal mycosis. The patient may present with facial pain, nasal blockage, purulent nasal discharge and cacosmia, the fungal ball being present unnoticed for years. Some patients do present as having other nasal problems and later on are found out to have a fungal ball incidentally. We present a case of 38 yearold man who was clinically diagnosed as having left antrochoanal polyp. Intraoperatively, a fungal ball was discovered in the left maxillary antrum.
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Pólipo antrocoanal (PAC) ou pólipo de Killian é uma lesão benigna, não atópica, do seio maxilar. O sintoma predominante é a obstrução nasal. Diversas opções cirúrgicas para o tratamento dos PACs têm sido sugeridas para minimizar a recorrência pós-operatória. A endoscopia vem sendo utilizada como opção terapêutica na ressecção intra-sinusal maxilar da implantação do pólipo através do próprio óstio maxilar ou de uma antrostomia meatal média, com uma menor morbidade que as outras condutas cirúrgicas. OBJETIVO: Avaliar o índice de recidiva da polipectomia endoscópica com meatotomia média no tratamento do PAC. MATERIAL E MÉTODO: Foram avaliados, em estudo retrospectivo, 29 pacientes com o diagnóstico de PAC baseado na história, exame físico, tomografia computadorizada e exame anatomopatológico, tratados entre 1997 e 2004. O procedimento cirúrgico adotado foi polipectomia endoscópica com meatotomia média. RESULTADOS: 29 pacientes com pólipo antrocoanal, 17 (58,6 por cento) do sexo feminino e 12 (41,4 por cento) do masculino, com idades entre 7 e 75 (média 27,55 anos), foram incluídos nesse estudo. Os principais sintomas apresentados foram obstrução nasal, 24 (82 por cento), respiração oral, 11 (37,9 por cento), roncos, 9 (31 por cento), rinorréia, 5 (17 por cento), epistaxe, 2 (6,9 por cento), cefaléia, 2 (6,9 por cento) e gotejamento, 1(3,4 por cento). A associação com atopia foi de 9 (31 por cento). A média de seguimento foi de 17 meses (3-63 meses). Apenas 2 pacientes (6,9 por cento) apresentaram recidiva. CONCLUSÃO: O índice de recidiva obtido por nosso trabalho não difere dos dados da literatura, mesmo quando comparado com procedimentos longamente estabelecidos.
Antrochoanal polyp (ACP) or Killian polyp is a benign nonatopic lesion of the maxillary sinus. Patients usually present nasal obstruction. Many surgical options for the treatment of ACPs have been suggested to minimize postoperative recurrence. The endoscopic nasal approach is a surgical option for maxillary intrasinusal resection of the polyp implantation through the maxillary ostium or middle meatal antrostomy, with lower morbidity when compared to other surgical approaches. AIM: To evaluate the rate of endoscopic antrochoanal polypectomy with middle meatotomy in the treatment of ACP. MATERIALS AND METHODS: Were evaluated by means of a retrospective study, 29 patients, who were diagnosed based on history, physical examination, computed tomography, and histological findings, treated between 1997 and 2004. The surgical approach was endoscopic polypectomy with middle meatotomy. RESULTS: Twenty-nine patients with ACP, 17(58.6 percent) were females and 12(41.4 percent) males, age range, 7-75 years (average of 27.55years) were included in this study. The main symptom were nasal obstruction 24(82 percent), oral breathing 11(37.9 percent), snoring nine (31 percent), rhinorrhea 5(17 percent), epistaxis 2(6.9 percent), headache 2(6.9 percent), and drip one (3.4 percent). The association with atopy was found in nine (31 percent). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9 percent) presented recurrence. CONCLUSION: The rate of recurrence obtained in our study is no different from literature data, even when compared with former and gold standard procedures.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Endoscopy/methods , Nasal Polyps/surgery , Follow-Up Studies , Otorhinolaryngologic Surgical Procedures/methods , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: Nasal polyp (NP) and antrochoanal polyp (ACP) are soft tissue masses, featuring chronic inflammation and tissue remodeling. To elucidate the mechanism of tissue remodeling, we investigated the expressions of matrix metalloproteinase-2 (MMP-2) and MMP-9 in ACP and NP and compared them with normal inferior turbinate mucosa. SUBJECTS AND METHOD: Nasal samples, obtained from controls (n=10), from ACP (n=10) and from NP (n=13), were analysed by immunohistochemistry. MMP-2/-9 expression was identified in epithelial, endothelial, gland, inflammatory cells. We assessed MMP-2/-9 immunoreactivity of ACP and NP in comparison with the normal inferior turbinate. The number of immunostained inflammatory cells were determined. RESULTS: In ACP, compared with controls, the MMP-2 expression was increased in vessel endothelium, while the MMP-9 expression was increased in vessel endothelium and inflammatory cells. In NP, compared with controls, increased expression of MMP-9 was observed in gland and inflammatory cells. CONCLUSION: ACP showed increased expression of MMP-2/-9, while NP showed increased expression of MMP-9. It is concluded that MMP-2/-9 in ACP and MMP-9 in NP may play a role in tissue remodeling.
Subject(s)
Endothelium , Immunohistochemistry , Inflammation , Matrix Metalloproteinase 2 , Mucous Membrane , Nasal Polyps , Polyps , TurbinatesABSTRACT
BACKGROUND AND OBJECTIVES: The aims of the current study are to reintroduce a surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by evaluating the outcome of the patients. MATERIALS AND METHOD: A prospective study was performed in 28 patients undergoing endoscopic sinus surgery for ACP by the author's surgical technique. Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow-up period ranging from 12 to 52 months. All symptom scores on a 100 mm visual analog scale before operation were compared with those obtained at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three-point scale ranging from 0 to 2. In the surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa. RESULTS: Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow-up period. There were no major complications specific to this technique. CONCLUSION: This technique provides an attractive alternative to other methods for removing the antral portion of ACP and is associated with excellent outcomes and the minimal morbidities rate.
Subject(s)
Humans , Endoscopy , Follow-Up Studies , Polyps , Prospective Studies , Visual Analog ScaleABSTRACT
Antrochoanal polyp (ACP) usually appears as a large, soft, gelatinous mass in the nasopharynx. Recently, ACP is considered as a separate entity among sinonasal polyps. Histologically, the antral part of the polyp can be cystic or polypoid with a fibrous and solid choanal part. However, the extent of inflammation of the paranasal sinuses has not well been demonstrated. In addition, pathologic patterns of ACP have not been well revealed. The aim of our study is to evaluate the disease patterns of ACPs by clinical and pathologic analysis. Thirty two patients with ACPs were evaluated by a retrospective study. We evaluated sinus involvement by operative findings and pathologic patterns were investigated in 28 cases by predominant infiltrating cells and types of polyp. In order to evaluate the histologic differences between the antral and choanal portion, each A CP was divided into proximal and distal portion. The involved sinuses were multiple and diverse and the most of them had a polyp. The most common pathologic type was chronic inflammatory polyp. Lymphocyte and neutrophil were visualized in many ACPs predominantly. The histologic differences between the proximal and distal portion was not observed significantly. Clinical analysis suggest that ACPs are not sole polyp but mixed disease with inflammation of the nose and sinuses in most cases. Histologic analysis suggest that ACPs are caused by chronic inflammation in many cases and each portion of ACPs is composed of the same histologic type.
Subject(s)
Humans , Gelatin , Inflammation , Lymphocytes , Nasopharynx , Neutrophils , Nose , Paranasal Sinuses , Polyps , Retrospective StudiesABSTRACT
Antrochoanal polyp (ACP) is usually unilateral and occurs most commonly in children. However, bilateral ACP in children is extremely rare. In this paper, we report two such cases of bilateral antrochoanal polyps removed by functional endoscopic sinus surgery and discuss the etiology, diagnosis and management of nasal polyps in children.
Subject(s)
Child , Humans , Diagnosis , Nasal Polyps , PolypsABSTRACT
BACKGROUND AND OBJECTIVES: It is known that various inflammatory mediators released from the eosinophils and mast cells play important roles in the pathogenesis of nasal polyp. Among those mediators, the arachidonic acid has particular importance as a precursor of other mediators. By assaying the tissue concentration of the6-keto-PGF(1alpha), leukotrienes (LTs), and hydroxyeicosatetraenoic acids (HETE) in the nasal polyp, we aimed to investigate the role of arachidonic acid metabolite in the pathogenesis of antrochoanal polyp and nasal polyp associated with chronic paranasal sinusitis. MATERIALS AND METHODS:Three turbinate tissues taken during the septoplasty were served as the control. The experimental group consisted of 3 antrochoanal polyps and 7 inflammatory polyps. The tissue level of the 6-keto-PGF(1alpha), LTC(4), LTD(4), LTE(4), 15-HETE, and 12-HETE were measured using high performance liquid chromatography. RESULTS: The level of 6-keto-PGF(1alpha), LTC4, 15-HETE, 12-HETE were significantly lower in antrochoanal polyp than in the control turbinate. In the inflammatory polyp, the levels of 6-keto-PGF(1alpha) and LTC(4) were lower than the control. However, in the inflammatory polyp, LTD(4) and LTE(4) were detectable, which were not detected in the control turbinate and antrochoanal polyp. CONCLUSION: The results of this study indicate that the decreased arachidonic acid metabolism may underlie the pathogenesis of the antrochoanal polyp. However, in the pathogenesis of inflammatory polyp, the increased production of LTD(4) and LTE(4) may have an important role.
Subject(s)
12-Hydroxy-5,8,10,14-eicosatetraenoic Acid , Arachidonic Acid , Chromatography, Liquid , Eosinophils , Hydroxyeicosatetraenoic Acids , Leukotriene C4 , Leukotrienes , Mast Cells , Metabolism , Nasal Polyps , Polyps , Sinusitis , TurbinatesABSTRACT
This study was conducted to review the clinical features of antrochoanal polyp and to evaluate the effectiveness of transnasal endoscopic sinus surgery as a primary surgical method in treating antrochoanal polyp. We reviewed the profiles, which included clinical symptoms, past surgical history, surgical techniques and operative findings, of 57 patients (62 cases) treated for antrochoanal polyp with transnasal endoscopic sinus surgery during the past four years. Out of this subject pool, 45 patients (50 cases) underwent follow-up examinations and were analyzed. The follow-up periods ranged from 18 to 63 months and averaged 33 months. About half of the cases involved pediatric-to-young-adult patients (under 20 years) and five cases were bilateral. The most frequent site of origin was the natural ostium of the maxillary sinus, followed by the posteromedial wall and the posterolateral wall. Recurrences after endoscopic sinus surgery were observed in five cases, which were subsequently treated with revision endoscopic sinus surgery. In these cases of recurrence, there was no evidence of recurrence during a mean follow-up period of 30 months. These results suggest that transnasal endoscopic sinus surgery may be appropriate for the primary treatment of antrochoanal polyp and useful in the treatment of recurrent cases, especially those involving children.
Subject(s)
Child , Humans , Follow-Up Studies , Maxillary Sinus , Polyps , RecurrenceABSTRACT
BACKGROUND AND OBJECTIVES: Antrochoanal polyp usually appears as a large, soft, gelatinous mass in the nasopharynx. Most incidents of antrochoanal polyp arise from mucosa around the natural ostium of the maxillary sinus. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc's operation, osteoplastic maxillary sinus operation, inferior meatal antrostomy, as well as endoscopic removal. Simple avulsion has been known to accompany a high recurrence rate, whereas the incidence of recurrence has been reported to be lower for endoscopic sinus surgery. In this regard, we compared postoperative results of simple avulsion or Caldwell Luc's operation with endoscopic sinus surgery in treating antrochoanal polyp. MATERIALS AND METHODS: We evaluated 42 patients who were treated for antrochoanal polyp from April 1991 until April 1996 by analyzing their clinical features, radiologic findings, postoperative results, and postoperative complications. RESULTS: Simple avulsion method was used to treat 21 cases (50%), and endoscopic sinus surgery method was used to treat another 21 cases (50.0%, three cases were combined with Caldwell-Luc's operation). Among those who received simple avulsion treatment, 9 showed recurrence, whereas none of those who underwent endoscopic sinus surgery and were treated successfully showed recurrence. CONCLUSION: The results suggest that endoscopic sinus surgery is a successful surgical method for treating antrochoanal polyp.
Subject(s)
Humans , Gelatin , Incidence , Maxillary Sinus , Mucous Membrane , Nasopharynx , Polyps , Postoperative Complications , RecurrenceABSTRACT
BACKGROUND: Many studies on the outcome of endoscopic sinus surgery(ESS) reported that patients' symptoms were much improved but surgeons were not so satisfied with endoscopic and radiologic findings postoperatively. One of the reasons may be that it is hard to manage diffuse poyposis(DP) within the maxillary sinus(MS) sufficiently with preexisting techniques. OBJECTIVES: The aim of this study is to introduce a new surgical technique of managing DP and antrochoanal polyp(ACP) within MS using a microdebrider in ESS and to evaluate the surgical outcome with our preliminary results prospectively. MATERIALS AND METHODS: Symptoms, endoscopic and computed tomographic(CT) findings were evaluated in 10 patients with 18 MS's with the mucosa showing DP and six ACP patients, who underwent ESS and were followed up over six months after surgery in our department from November, 1995 through October, 1996. RESULTS: Of the patients with DP, 88.9%, 77.8% and 75.0% reported an improvement in symptoms of nasal obstruction(NO), rhinorrhea and postnasal drip(PND) respectively, and endoscopic and CT findings were improved in 77.8% and 88.9% of the 18 MS's with DP. Improvement in NO, rhinorrhea and PND was observed in 100.0%, 100.0% and 80.0% of the six ACP patients respectively, and both endoscopic and CT findings were improved in 100.0% of the six MS's with ACP. CONCLUSION: This surgical technique using a microdebrider is effective in management of DP and ACP within MS's in ESS.
Subject(s)
Humans , Maxillary Sinus , Mucous Membrane , Polyps , Prospective StudiesABSTRACT
To evaluate the result of endoscopic surgery in the treatment of antrochoanal polyps (ACPs), 34 consecutive patients were monitored from February 1991 through June, 1996 in Seoul National University Hospital. Ten cases were treated by osteoplastic Caldwell-Luc antrostomy, 23 cases by endoscopic surgery, and 1 case by both procedures. In all cases, the polyps were removed completely. Two cases recurred: one after endoscopic approach, and the other after both of the procedures. They were treated again by endoscopic approach with no more recurrence. The endoscopic removal of ACPs are an alternative to conventional surgical treatment with a low rate of recurrence and complications, especially in children.