Caldwell-Luc Operation Research Articles

Extranodal Sinonasal Natural Killer/T-Cell Lymphoma Presenting as Chronic Sinusitis and Necrotic Wound Infection

A case of a 43-year-old white woman who was admitted to our clinic with the complaints of chronic sinusitis and wound infection after Caldwell-Luc operation performed for chronic sinusitis is presented. Necrotic lesion then extended to the nasal cavity and skin of the face. The biopsy revealed natural killer/T-cell lymphoma. The patient was treated with chemotherapy; however, the patient died owing to sepsis. Sinonasal lymphoma is a rare disease. It is managed with chemotherapy and radiotherapy. The prognosis is poor. A high index of clinical suspicion is required for early diagnosis.

P.055 The use of micro-CT in craniomaxillofacial surgery

In the standard Caldwell-Luc operation, an inferior meatal antrostomy is performed to promote sinus drainage. However, inferior meatal antrostomy has been criticized for its additional operation time and wound, early loss of the opening, and risk of injury to the nasolacrimal duct. This study retrospectively reviewed the results of the Caldwell-Luc operation without inferior meatal antrostomy in the treatment of odontogenic maxillary sinusitis or odontogenic sinus disease.The records of 50 patients who had an odontogenic sinus disease and underwent the Caldwell-Luc operation without inferior meatal antrostomy were reviewed. The data included the patient's age, gender, surgical indications, surgical condition, and complications.From April 2004 to October 2010, there were 27 male patients and 23 female patients aged 14 to 70 years (mean, 37 years) who underwent the modified Caldwell-Luc operation. The surgical indications included intrasinus odontogenic cysts (44%), oroantral fistulae with chronic sinusitis (44%), odontoma (4%), odontogenic sinusitis (4%), and foreign bodies in the maxillary sinus (4%). The patients were successfully treated with minimal complications.The modified Caldwell-Luc operation provides easier postoperative care and involves fewer complications. It is not necessary to create the inferior meatal antrostomy in the Caldwell-Luc operation when treating odontogenic sinus disease.

Application of an Intranasal Drill on Transnasal Endoscopic Marsupialization of Postoperative Maxillary Mucoceles

Objective Postoperative maxillary mucoceles occur as a delayed complication of radical surgical intervention in the maxillary sinus. Conventionally, the recommended procedure for treating this entity has been the revised Caldwell-Luc operation. In this study, we present a less invasive treatment methodology which is as safe and effective. Materials and Methods Between January 1988 and December 2006, inclusively, 36 patients (47 sides) were enrolled in the study. Twenty-eight patients (38 sides) underwent the endoscopic marsupialization technique. Eight patients (9 sides) received a revised Caldwell-Luc operation, and this group was used as the control. Under nasoendoscopic guidance, an antrostoma was created through the inferior (29/38) or middle (9/38) meatus, and the opening was then enlarged to a diameter almost equal to that of the mucocele itself. A 15° intranasal drill was used where the medial wall of the maxillary sinus was bony. Results Only one patient complained of mild cheek pain after marsupialization surgery. The opening remained patent in 89.5% (34/38) of the mucoceles 1 year after the transnasal endoscopic operation. Twenty of the 38 maxillary sinus mucoceles had a bony wall between the membranous mucocele and the nasal cavity, while the wall was membranous in the remaining 18. Stoma closure was noted in four mucoceles at an average of 4.1 weeks after the operation. A statistically significant tendency for stoma closure was observed for mucoceles with bony walls adjacent to the inferior or middle meatus compared with membranous ones. Conclusion The transnasal approach using a powered instrument has the advantage of decreased postoperative suffering. Based on the results of this study, it appears reasonable to suggest that this is a useful treatment method for a unilocular mucocele adjacent to the medial wall of the antrum.

Complications of maxillary sinus augmentations in a selective series of patients

The purpose of this case series was to describe late complications of maxillary sinus augmentation procedures, including paranasal sinusitis and oroantral fistula, and to discuss the definitive surgical methods of treatment. The case series included 13 patients hospitalized for a failed lateral-approach maxillary sinus augmentation, performed by a dental practitioner, with or without simultaneous implant placement. Data on patient gender and age, presenting signs and symptoms, radiographic appearance, method of repair, and follow-up were recorded. There were 7 female and 6 male patients aged 53-74 years. Twenty-six of the total 34 implants inserted failed, of which 7 were displaced into the sinus. All patients had maxillary sinusitis, and 2 also had an inflammation of other paranasal sinuses. Ten patients presented with an oroantral fistula. Review of the files of the referring practitioner revealed the preoperative presence of chronic maxillary sinusitis in 4 patients and an odontogenic cyst in 1. Caldwell-Luc operation served as the definitive surgical treatment. All fistulas were successfully closed by a palatal rotation advancement flap (8 patients) or a buccal flap (2 patients). Thorough clinical and radiographic evaluation is necessary before sinus procedures to minimize complications. Total elimination of sinusitis and other pathologic conditions is recommended before maxillary sinus augmentation and implant surgery.

Sinonasal imaging after Caldwell–Luc surgery: MDCT findings of an abandoned procedure in times of functional endoscopic sinus surgery

Background and purpose Today, functional endoscopic sinus surgery (FESS) is performed in most of the patients with sinonasal inflammatory disease. The postoperative imaging findings of FESS in multidetector computed tomography (MDCT) considerably differ from those of historic Caldwell–Luc (CL) maxillary sinus surgery which is an uncommon procedure today. Thus, the postoperative CL imaging findings may lead to diagnostic confusion and misinterpretation. Therefore, this study explicitly presents the MDCT findings of post-CL patients which have not been described previously. Methods Twenty-eight patients with clinically suspected sinusitis and documented history of CL-procedure underwent 16 row MDCT (MDCT Mx8000 IDT Philips) with multiplanar reconstructions of the paranasal sinuses in the axial plane. The following parameters were used: 140 kV, 50 mAs; 16 mm × 0.75 mm detector collimation; 1 mm reconstructed slice thickness; 0.5 mm increment. The studies were reconstructed with a bone algorithm (W3000/L600; 1 mm slice thickness) in axial plane and coronal plane (3 mm slice thickness). The images were retrospectively evaluated for the presence of normal surgery-related and pathological findings. Results Surgery-related imaging characteristics presented as follows: an anterior and a medial bony wall defect and sclerosis and sinus wall thickening were observed in all 28/28 cases (100%). Collaps of the sinus cavity was seen in 26/28 cases (92.9%). Furthermore, inflammatory disease of the operated sinus(es) was found in 23/28 cases (82.1%): 14/28 patients (50%) had inflammatory mucosal thickening of the operated sinus(es) as well as of other sinonasal cavities and 9/28 patients (32.1%) had inflammatory mucosal thickening limited to the operated sinus(es). A postoperative mucocele was depicted in 3/28 cases (10.7%). 2/28 patients (7.1%) showed neither maxillary nor other mucosal swelling. Conclusion MDCT with multiplanar reconstructions is a precise method to evaluate post-CL patients and helps to differentiate normal surgery-related findings, which may mimic pathology, from real pathological findings.

Fístula oroantral e retalho mucoso geniano: revisão de 25 casos

A fístula oroantral é a comunicação patológica entre cavidade oral e seio maxilar, quase sempre decorrentes de traumatismos durante procedimentos dentários. OBJETIVO: Apresentar experiência de 25 casos. CASUÍSTICA E MÉTODOS: Realizado estudo retrospectivo de pacientes com FOA no período de 1996 a 2000. O diagnóstico incluiu exame otorrinolaringológico, endoscopia nasal ou da fístula, tomografia computadorizada das cavidades paranasais, pesquisa bacteriológica, fúngica e análise patológica. RESULTADOS: Encontrados 25 casos, sendo 10 de segundo molar, 8 de primeiro molar, 6 de segundo pré-molar e 1 de canino. Todos foram operados pela técnica de Caldwell-Luc, reavivamento das bordas da fístula, meatotomia média e rotação de retalho mucoso geniano. DISCUSSÃO: Nas fístulas de alto débito (n=14), colocou-se enxerto ósseo da própria parede anterior do seio. Todos, exceto um, tiveram resultado cirúrgico bom. A cultura bacteriológica (n=19) demonstrou estreptococos pneumoniae (13), haemophilus influenzae (6), moraxella catarrhalis (2), estafilococos aureus (2). Encontrado aspergilus niger em um caso que apresentava imagem radiológica de bola fúngica. CONCLUSÕES: Após 30 dias, os resultados foram bons em todos, exceto um dos casos. Este foi reoperado com colocação de enxerto ósseo, inicialmente não utilizado, tendo sucesso. Após 6 meses, todos os 23 pacientes localizados não apresentavam problemas.

A modified free gingival graft technique for the treatment of oro-antral sinus track: A case report

Purpose: Surgical intervention into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing of 1 to 2 mm openings can occur. However, in patients with larger oro-antral communications and those with a history of sinus disease, surgical closure is often indicated. Materials and Methods: In this case, a modified free gingival graft technique was used. The oro-antral sinus track after extraction was about 2×4 mm. But the patient had a history of Caldwell-Luc operation. Immediately after extraction, a modified free gingival graft was used for the closure of oro-antral sinus track. Result: A modified free gingival graft technique was successfully used for the closure of oro-antral sinus track. With this technique, esthetic results including similar colors, textures were achieved. Conclusion: It is thought that this technique is very useful in the closure of oro-antral sinus track. (J Korean Acad Periodontol 2008;38:109-114)

Oroantral fistula and genian mucosal flap: a review of 25 cases

SummaryThe oroantral fistula is a pathological connection between the maxillary sinus and with the oral cavity. The condition mostly follows dental extraction.AimTo present the experience of 25 cases.Material and methodsRetrospective cases between 1996–2000. The ORL examination included nasal or sinusal endoscopy, a CT scan and histopathological analysis.ResultsTwenty-five cases were found: ten 2nd molar cases, eight 1st molar cases, six 2nd premolar cases, and one canine case. All patients underwent a Caldwell-Luc operation plus excision of the epithelium lining the fistula, that was then completely covered by a flap of mucosa rotated from the genian region.DiscussionIn cases of major fistulae a bone autograft taken from the anterior sinus wall was used. Bacterial cultures (n=19) revealed streptococus pneumoniae (13), haemophillus influenza (6), Moraxella catharralis (2) and staphylococus aureus (2). Aspergillus niger was found in one case presenting as a “fungic ball”.ConclusionsThe only case of surgical failure, after 30 days postoperatively, was reoperated, using a bone graft. After a 6-month follow up all of the patients progressed satisfactorily, including the reoperated patient.

Endoscopic radical antrectomy: a permanent replacement for the Caldwell–Luc operation

Chronic inflammation of sinus mucosa is a multifactorial condition which sometimes results in irreversible pathological mucosal changes. To evaluate the efficacy of endoscopic radical antrectomy in treating chronic, hyperplastic, eosinophilic sinusitis, and to compare this procedure with classical endoscopic middle meatal antrostomy. A randomised, controlled trial with parallel design was conducted between July 2000 and December 2004, including 119 patients who fulfilled the clinical, radiological and histopathological criteria for chronic, hyperplastic, eosinophilic sinusitis. Patients were randomly allocated to two treatment groups: classical endoscopic middle meatal antrostomy and endoscopic radical antrectomy. The main outcome measures were recorded in each subgroup at the time of the patient's last clinic visit. In each subgroup, these included subjective improvement and evaluation of the endoscopic appearance of the maxillary sinus. Thirty-two per cent of patients in the endoscopic middle meatal antrostomy group were considered surgical failures, compared with 14.5 per cent of the endoscopic radical antrectomy group. This was statistically significant (p = 0.023). Unhealthy maxillary sinuses were significantly more prevalent in the endoscopic middle meatal antrostomy group (p = 0.029). In those patients fulfilling the criteria suggestive of chronic, irreversible sinonasal pathology, primary endoscopic radical antrectomy was significantly better than endoscopic middle meatal antrostomy, based on subjective and objective findings.

Primary and secondary fungal infections of the paranasal sinuses: Clinical features and treatment outcomes

Conclusion. In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended. Objective. The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses. Materials and methods. Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection. Results. The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Luc's operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.

Inflammatory Pseudotumor of the Sinonasal Tract

Inflammatory pseudotumors (IPTs) are a clinically and histologically diverse group of lesions characterized by a tumor mass of acute and chronic inflammatory cells with a variable fibrous response. IPTs most commonly involve the lung and orbit, but rarely the sinonasal tract. We report a 68-year-old male with an IPT of the sinonasal tract presenting as nasal obstruction and postnasal dripping for several years. A gray-white soft mass was noted in the right nasal cavity. Computed tomography revealed a solid mass filling the right nasal cavity and maxillary sinus. Caldwell-Luc operation with ethmoidectomy (right) was conducted to resect the mass en bloc. Pathology revealed admixture of plasma cells, lymphocytes and eosinophils, confirming the diagnosis of IPT. The patient remained symptom-free over 4 years of follow-up. Awareness of the clinical presentations, histopathologic features and treatment of choice of this rare disease entity is necessary to distinguish it from malignancy and avoid unnecessary management.

Nasal polyps - clinical profile and management in Ibadan, Nigeria

Background: Nasal polyps are benign mucosal protrusions into the nasal cavity of multifactorial origin and are characterized by chronic mucosal inflammation. They result from the prolapsed lining of the ethmoid sinuses and block the nose to a variable degree depending on their sizes. This study aims to evaluate the clinical profile and management of nasal polyposis as seen in Ibadan, Nigeria. Method: A 5-year (1998-2002) prospective study of 63 nasal polyposis patients depicting the clinical profile and implications was done at the department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria. Results: There were 38(60%) males and 25(40%) females with M: F of 1.5:1 and with an average age of 34 years. The duration of symptoms ranged from 2months –14years with an average occurrence of 12 new cases a year. The main clinical presentations were nasal obstruction 95%, nasal discharge 81%, sneezing 59% and observed nasal polyps 78%. The polyps were found in the right nasal 16%, left nasal 25% while bilateral 37%. The rest were of antro-choanal polyps 22%. Polyps from ethmoidal region constituted 88% while from lateral nasal wall 12%. Treatment is a combination of surgery and medical therapy with topical corticosteroids. Eighty-Seven percent (87%) of the cases had surgical treatment; simple polypectomies 67%, Caldwell-Luc's operations 15%, and external ethmoidectomies 13% while internal ethmoidectomies 5%. The hospital stay ranged from 1- 6 weeks with recurrence rate of 13% and onset of recurrence ranged from 2 weeks – 4 years. Conclusion: Whatever therapeutic regimen is used nasal polyps are a chronic common condition in which their cause remain unknown, are prone to recurrence and in some cases with embarrassing frequencies. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 164-167

Endoscopic sinus surgery for maxillary sinus mucoceles

BackgroundMaxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles.MethodsBetween 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed.ResultsThere were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery.ConclusionThe most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome.

Management of recurrent sinus disease in children with cystic fibrosis: A combined approach

To determine whether a combined approach (CA) consisting of functional endoscopic sinus surgery (FESS), Caldwell-Luc operation, and medial maxillectomy is beneficial for children with cystic fibrosis (CF) with refractory sinonasal disease previously treated with endoscopic procedures alone. Retrospective review and comparison of outcomes of CA and FESS alone for each CF patient. sinonasal symptoms, endoscopic findings, number of hospitalizations, antibiotic courses, and forced expiratory volume in 1 second (FEV1). Referral hospital. Fifteen children underwent CA between 1996 and 2000 (7 males, 8 females; 13.8 years mean age; 42 months average follow-up period). Significant decrease in number of hospitalizations and intravenous antibiotic courses, with increased mean FEV1 (from 70.2% preoperation to 89.3% postoperation, P < 0.0001) were found. Marked clinical improvement persisted for several years. Applying the CA after multiple failed endoscopic procedures in CF patients reduced morbidity and resulted in successful management of sinonasal disease. CA is suggested after multiple failed endoscopic procedures. Further studies of CA as a first-line procedure for difficult sinus cases in children with CF is recommended. C-4.

Evaluation and Treatment of Antrochoanal Polyps

Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through a sinus ostium, and extends into the choana. The common presentation of ACP is unilateral nasal obstruction. The radiographic findings and differential diagnosis of ACPs are discussed by comparing them with data in the literature. This study included 19 (14 male, 5 female; median age 24.5 years, range 8-75 years) surgically treated patients with ACPs diagnosed by clinical examination, nasal endoscopy, and computed tomography. Nasal obstruction was found in all cases. Endoscopic sinus surgery was preferred for removal of the nasal part of ACPs in 13 cases. Only in one case, polypectomy combined with Caldwell-Luc operation and septoplasty was performed. The observed complications were as follows: minor hemorrhage in three cases, mild cheek swelling with pain in two patients, and infraorbital hypoesthesia in one case. Histopathologic examination of ACPs revealed loose mucoid stroma and mucous glands, which were covered by respiratory epithelium. Endoscopic sinus surgery may be indicated in patients with ACPs because the function and capacity of the maxillary antrum are preserved. The greater portion of the antral part of polyp can be removed while leaving the healthy antral mucosa intact.

Quantification and detection of bacteria from postoperative maxillary cyst by polymerase chain reaction

Postoperative maxillary cyst (POMC) is known to occur as a delayed complication of radical maxillary sinus surgery, such as Caldwell-Luc surgery. The cyst gradually expands with no symptoms over a period of years, and then occasionally causes swelling and pain in the buccal region and/or the mucogingival fold. It is probable that bacterial infection affects the progression of POMC symptoms. The aims of this study were to determine the bacterial density and to examine the presence of 20 oral bacteria in POMC fluids. POMC fluids (4 purulent, 2 mucous and 4 serous) were sampled from 10 subjects (aged 43-77 years). Bacterial quantification and detection were performed by real-time polymerase chain reaction (PCR) and nested PCR based on bacterial 16S rRNA genes, respectively. Bacterial DNA was detected in all samples and the average concentrations of bacterial DNA were 5.9 (purulent), 0.5 (mucous), and 0.7 (serous) ng/mg of sample. Twelve bacterial species, including anginosus streptococci, known to be associated with abscess formation, were detected in the purulent fluids, while two and five species were detected in the mucous and serous fluids, respectively. Purulent fluids contained numerous bacteria of various types, thus suggesting that oral bacteria may cause symptoms such as pain in POMC with purulent fluids. Mucous and serous fluids also contained bacteria, although their numbers were small, thus suggesting an association between bacteria and progression of POMC.

Indications for the Caldwell-Luc approach in the endoscopic era

Caldwell and Luc described the Caldwell-Luc operation more than 100 years ago as the surgical treatment for maxillary sinus disease. During the last decades less radical interventions using endoscopic approach have mainly replaced the classical procedures done for chronic and recurrent maxillary sinusitis. Between 1991 and 2002, 62 patients had the Caldwell-Luc approach for different indications. Twenty (32%) patients had chronic sinusitis, 16 (26%) patients had inverted papilloma, 9 (15%) patients had suffered from nasal polyposis, 4 patients (6%) had dentigerous cyst, 4 (6%) patients had fungal ball, and 9 (15%) patients were operated for other indications. The use of this surgical approach is rational in cases of fungal disease and in endoscopic medial maxillectomy for treating inverted papilloma. In all other cases, the preferred approach should now be endoscopic.

Cholesterol granuloma of the maxillary sinus resembling an invasive, destructive tumor

The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors' clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. Radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.

Inferior meatal antrostomy: is it necessary after radical sinus surgery through the Caldwell-Luc approach?

Purpose In the Caldwell-Luc (CWL) operation, an antrostomy at the inferior meatus is created surgically to promote sinus drainage. This inferior meatal antrostomy (IMA) has been criticized because of the need for an additional time, early loss of the sinusotomy, injury to the nasolacrimal duct, epistaxis from the sphenopalatine artery, and deviation from the normal sinus physiology. This trial was undertaken with specific attention to the question: Is it necessary to perform antrostomy at the inferior meatus after radical sinus surgery through the CWL approach? Materials and methods Thirty-three patients with a dental origin of sinus disease indicating the CWL operation were entered into this trial. They were treated in blocks of 3, in which IMA was not performed in the first and second patients of each successive block. Only the third patient of each block had IMA performed. Cheek swelling, infection, and failure to relieve the patient’s symptoms were the criteria for comparison between patient groups. Cheek swelling was measured by the eye-mouth line and the ear-nose line on the second and fourth day after surgery. Results At no time was there a statistically significant difference in cheek swelling between the treated groups ( P > .05). No infection or failure of treatment was encountered. However, some patients in both groups had numbness or paresthesias of the cheek, upper lip, upper front gingiva, and teeth. These complaints were transient and lasted for several weeks. Conclusion Based on our findings, it does not seem necessary to perform antrostomy at the inferior meatus, provided the patient has a patent osteomeatal complex and no anatomic abnormalities.

Antrochoanal Polyps: Clinical Presentation and the Role of Powered Endoscopic Polypectomy

Antrochoanal polyps are a rare clinical entity. In this review of patients treated between January 1996 and September 2002, there were 18 cases of antrochoanal polyps. The mean age of patients was 20 years. Nasal obstruction was the most common symptom (17 cases, 94%), followed by rhinorrhoea (44%), epistaxis (33%), postnasal drip (28%), and snoring (22%). Chronic sinus was the most common associated rhinological finding (50%). Various surgical approaches were used: endoscopic polypectomy and middle meatal antrostomy in seven patients (38.9%), endoscopic polypectomy and inferior meatal antrostomy in three patients (16.7%) and Caldwell-Luc surgery in one patient (5.6%). No complications were noted in patients treated with powered instrumentation, including the three patients in whom combined transcanine approaches were used. We concluded that powered endoscopic polypectomy was safe and effective. It allowed a more complete dissection and may diminish the chance of recurrence.