Antral choanal polyp presenting as obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) in children is commonly caused by adenotonsillar hypertrophy. The diagnostic criteria of OSAS in children are not so well delineated as in adults. We report the first case of antral choanal polyp presenting as OSAS in a 10-year-old boy that initially presented to the child psychiatry service for behavior disturbance, enuresis, and daytime somnolence. Overnight electroencephalogram sleep study revealed events consistent with OSAS. Multiple inhalant allergies, chronic maxillary sinusitis, and obstructive adenoid hypertrophy were diagnosed by the allergy and otolaryngology services. The child was scheduled for adenoidectomy when his sleep apnea symptoms persisted following antimicrobial therapy. Examination under anesthesia revealed a normal adenoid bed and a large left antral choanal polyp. Polypectomy was performed as dictated by parental consent. Postoperatively treatment with an intranasal steroid was begun. However, polypoid nasal mucosa recurred in 2 months and a Caldwell-Luc procedure was performed. Subjective reports following surgery indicated improvement in daytime irritability, attention, and mood. A follow-up overnight electroencephalogram sleep study confirmed resolution of OSAS.

Surgical management of the mass in the buccal space.

The discovery of a mass in the buccal space provides a diagnostic and therapeutic challenge. A common approach for the removal of the mass in the buccal space has been through the oral cavity. However, there is an ever-present danger of injury to the facial nerve and Stensen's duct with this approach. Experience with tumors in this area prompted a review of the anatomy of the buccal space and resulted in an improvement in the surgical technique. Our external approach through an extended parotid-submandibular incision provides excellent exposure which minimizes the risk of complications during excision of these tumors and provides an excellent cosmetic result.