Abstract
Antrochoanal polyps (ACP) are benign lesions that arise from the mucosa of the maxillary sinus. Large antrochoanal polyps may extend in to the nasopharynx and beyond hyoid bone and reach almost up to the epiglottis. We present our experience of airway management for FESS in an 11-year child with a giant atypical antrochoanal polyp extending in to the oral cavity.
Highlights
Antrochoanal polyps represent 4-6% of all nasal polyps
Due to its large size causing airway obstruction and the age of the patient, it was decided to perform the removal by FESS under general anesthesia
Preserving spontaneous respiration, a check direct laryngoscopy was done with Macintosh laryngoscope to examine the access available for airway management which revealed a Cormack Lehane Gr III view
Summary
Antrochoanal polyps represent 4-6% of all nasal polyps. Chronic sinusitis and allergy are believed to be the possible aetiological factors. Anaesthetic management of patients with large antrochoanal polyps needs anticipation and adequate preparation for the associated problems. CT Scan of paranasal sinuses revealed a large soft tissue density lesion in left maxillary sinus extending from the ostia to posterior nasal cavity and choana with posterior extension beyond the base of the tongue in to the oral cavity. Due to its large size causing airway obstruction and the age of the patient, it was decided to perform the removal by FESS under general anesthesia. Preserving spontaneous respiration, a check direct laryngoscopy was done with Macintosh laryngoscope to examine the access available for airway management which revealed a Cormack Lehane Gr III view. The oral part of the polyp showed metaplastic changes towards the distal end and which was friable, due to careful laryngoscopy there was no bleeding during airway management.
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