Choanal Polyp Research Articles

Clinical and Histological Differences Between Choanal Polyps in Children and Adults: A 15-Year Retrospective Study.

Choanal polyps (CPs) are benign, inflammatory, solitary lesions extending toward the junction between the nasal cavity/paranasal sinus and the nasopharynx through the choana. This study aimed to evaluate the clinical and histological characteristics of CPs in children compared to adult patients. Characteristics of patients (demography, main complaints, side, localization, surgical approach, histological characteristics, accompanying chronic rhinosinusitis [CRS], association with allergic rhinitis [AR] and aspirin sensitivity, postoperative follow-up period, recurrence rates) were retrospectively reviewed. The patients were classified into children (<18 years) and adults (≥18 years). Our results suggest some clinical and histological specificities of CPs in children compared to adults. Epistaxis, oropharyngeal extension, association with AR and ipsilateral CRS, and angiomatous histological subtype of CPs are more frequent in the pediatric population. Also, the level of eosinophil infiltration of polyp tissue and recurrence rates are higher in pediatrics than in adult population.

Choanal Polyps With Osseous Metaplasia From the Nasal Septum: A Case Report and the Literature Review.

Choanal polyps belong to a special type of nasal polyps, which are quite uncommon if originating from the nasal septum, especially those with osseous metaplasia. In this article, we report the case of a 63-year-old male patient with persistent nasal obstruction on the right side. An irregular light yellow lobulated mass with smooth surface could be visualized in the nasal cavity through nasal endoscopy, arising from the right nasal septum and extending to the nasopharynx. Computed tomography scan showed a large soft tissue shadow of the nasal meatus, with ossified structure in the center. Histopathological biopsy revealed nasopharyngeal mucositis. The patient underwent functional endoscopic sinus surgery and the polypoidal mass sent for histopathological examination proved to be choanal polyps.

A Case of Sinochoanal Polyp Originating From the Ethmoid Sinus

A nasal polyp is a distinct mucosal pathology that obstructs the nasal cavity and paranasal sinuses, with various phenotypes and endotypes. Nasal polyps should be distinguished from inverted papillomas, squamous cell carcinomas, juvenile angiofibromas, lymphomas, and olfactory neuroblastomas. A choanal polyp is a solitary benign lesion that originates in the paranasal sinus and extends to the choana through the natural ostium of the sinus. Choanal polyps usually originate from the maxillary sinus; however, we recently experienced the case of 41-year old women with sinochoanal polyp originated from the ethmoid sinus. As choanal polyps can recur even after appropriate surgery, complete resection, including the surrounding mucosa at the site of origin, is required. Therefore, it is essential to consider anatomical differences in polypectomy. We recently diagnosed and successfully performed surgery on an ethmochoanal polyp; herein, we report our experience and present a literature review.

Choanal polyps: Variant sites of origin

Choanal polyps: Variant sites of origin

ANTROCHOANAL POLYP: AN UNCOMMON CAUSE OF CHRONIC NASAL CONGESTION IN PEDIATRIC PATIENTS

<h3>Introduction</h3> Chronic nasal congestion is a common pediatric problem, caused most frequently by viral infections and environmental allergies. We describe a rare case of pediatric antrochoanal polyp causing nasal obstruction. <h3>Case Description</h3> A 10-year-old female with chronic nasal congestion, allergic rhinitis, snoring, recurrent sinus infections, and hyposmia was found to have a left-sided nasal mass after several years of progressive symptoms, despite treatment with nasal corticosteroids and anti-histamines. CT scan showed opacification of the left maxillary and sphenoid sinuses, bilateral ostiomeatal obstruction, and a small, lobulated mass obstructing the left nasal cavity. She had no other recurrent infections or family history of cystic fibrosis; immunoglobulin levels and sweat testing were normal. After otolaryngological evaluation, the mass was resected and found to be an antrochoanal polyp filling the entire chonae and left maxillary sinus. After surgery, her sense of smell returned, nasal congestion resolved, and she had no further infectious sinusitis episodes or polyp recurrence after four years. <h3>Discussion</h3> Pediatric nasal polyps are rare but should be considered in cases of chronic nasal congestion/obstruction. While antrochoanal polyps (arising from the maxillary sinuses) are most common in children, nasal polyps may also originate in the ethmoid/sphenoid sinuses (choanal polyps). Polyps can develop from prolonged mucosal inflammation in the setting of both eosinophilic and non-eosinophilic chronic rhinosinusitis. Lastly, pediatric nasal polyps can be associated with systemic diseases (including cystic fibrosis, primary ciliary dyskinesia, and immunodeficiency) and should prompt additional testing including sweat test and serum immunoglobulin levels.

A study about the nasal obstruction present in cases of malignancy in ent.

Tumours in the nasal cavity and paranasal sinuses were recognized during the time of Hippocrates. Whillis (1948) defined tumours as “an abnormal mass of tissue, the growth of which exceeds and is coordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the Change. From the table I it is evident that only 5 cases of malignant and 3 cases of fungal Granuloma, there was bony erosion. In 19 cases of antro chonal polyp and antrum and ethmoid sinus is found to be hazy. From the table I, on radiological study, sinuses are found to be hazy in 86.4% cases of antro choanal polyp and 89.4% cases of ethmoidal polyp. This finding is in accordance with that of miles (1971) who started that usually there is some degree of opacity of sinuses either due to thickening of mucosa or superadded infection. erosion of bone is found in 70% cases of malignancy and the 3 case of fungal granuloma.

Observation of various symptoms of non-neoplastic nasal mass in ent

Tumors in the nasal cavity and paranasal sinuses were recognized during the time of Hippocrates. Whillis (1948) defined tumors as “an abnormal mass of tissue, the growth of which exceeds and is coordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the Change” From the table I it is evident that only 5 cases of malignant and 3 cases of fungal Granuloma, there was bony erosion. In 19 cases of antro chonal polyp and antrum and ethmoid sinus is found to be hazy. From the table I, on radiological study, sinuses are found to be hazy in 86.4% cases of antro choanal polyp and 89.4% cases of ethmoidal polyp. This finding is in accordance with that of miles (1971) who started that usually there is some degree of opacity of sinuses either due to thickening of mucosa or superadded infection. erosion of bone is found in 70% cases of malignancy and the 3 case of fungal granuloma.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience.

Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction ( n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus ( n = 6), middle turbinate ( n = 3), posterior septum ( n = 3), sphenoid sinus ostium ( n = 1), and inferior meatus ( n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp ( n = 12), actinomycosis ( n = 1), and rhinosporidiosis ( n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

КИСТЫ ВЕРХНЕЧЕЛЮСТНЫХ ПАЗУХ У ДЕТЕЙ

Cysts of maxillary sinuses in both children and adults haven’t specific clinical manifestations and are often findings on CT or MRI and have an odontogenic or non­odontogenic origin. Systematized data of the prevalence and flow characteristics of this pathology in children are insufficient. Objectives: clinical and epidemiological analysis of cystic maxillary sinusitis in children. Material and methods: data of 42 patients of the children’s ENT­department who were operated for non­odontogenic cysts of maxillary sinuses. Results. Age of group patients in which the studied pathology was diagnosed most frequently was 10–17 years old. Correlation of the cysts of maxillary sinus with pathology of the nasal cavity and nasopharynx were analyzed: septal deviation (68 %), rhinitis (42 %), adenoids (10 %), anthroanal polyp (25 %) was noted. Pathomorphological examination of the material obtained at endoscopic removal of cysts presence of inflammatory in 78 % of biopsy. Conclusion. In most cases a patient with a cyst of maxillary sinus is subject to dynamic observation by an otorhinolaryngologist and endoscopic examination of the nasal cavity is an essential element for timely detection of pathology of the ostiomeatal complex or choanal polyp accompanying the cyst development.

Detection of TNF-α as a cofactor in the pathogenesis of nasal polypi

Objectives To detect the site of attachment of the antral part of the polyp and the prevalence of coexisting sinonasal anatomical variations in the antrochoanal polyp (ACP) side. Patients and methods A retrospective study of 57 patients treated for ACP was conducted between 2018 and 2020 in the Department of Otolaryngology of Kasr Alainy Hospital, Cairo University. All patients underwent a complete history, head and neck examination, nasal endoscopy, and computed tomography. Factors, including age, gender, associated symptoms, imaging findings, surgical approach, and the site of attachment of the antral part of the polyp, were recorded. Results This study included a total of 57 patients (33 males and 24 females). The mean age of the patient was 22±12.9 (range, 9–59) years. Mean age was 21.8 years for males and 23.6 for females. The major symptoms seen were constant and unilateral nasal obstruction in 34 (59.6%) patients. The exact origins of the polyps were located in different positions within the maxillary sinus and were able to be detected in 39 sides. It was detected in the anteroinferior antral wall on 16 sides, in the inferior antral wall on six sides, in the medial antral wall on six sides, in the lateral antral wall on six sides, and in the posterior antral wall on five sides. Conclusion Endoscopic approach for complete removal of the choanal polyps is an extremely safe and effective procedure. Despite the different approaches of ACP excision, the recurrence rates are still high. Keywords: antrochoanal polyp, computed tomography, endoscopic, recurrence.

A Case of Choanal Polyp Originated from the Inferior Turbinate

The choanal polyp, originating from inferior turbinate, is known to be extremely rare. We report a case of a 65-year-old woman who was treated for choanal polyp originating from inferior turbinate. She had felt left nasal obstruction for two weeks. In the endoscopic examination, polypoid tissue covered with the mucopurulent discharge was observed filling the left inferior meatus. An ovoid homogenous enhancing lesion in the left posterior nasal cavity around the inferior turbinate was observed on CT and MRI. Endoscopic mass excision with partial inferior turbinectomy was performed under general anesthesia. The pedicle of the polyp was observed on the posterior side of the inferior turbinate. Complete resection including the mucosa around the pedicle of the choanal polyp was performed. The patient was followed up for seven months without any recurrence or complications.

Management of Angiomatous Antrochoanal Polyp: Our Experience.

Antrochoanal polyps are the most common type of choanal polyp. Angiomatous polyp is a rare subtype of Antrochoanal polyp that might be misdiagnosed as malignant lesion due to its clinical features. A retrospective observational study was conducted in a tertiary care hospital in patients who were diagnosed with Angiomatous Antrochonal polyp that underwent functional endoscopic sinus surgery from 2017 to 2020. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with Angiomatous Antrochonal polyp. Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. Antrochoanal polyps all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction are typical on computed tomography imaging but specific for Angiomatous Antrochoanal polyp. The magnetic resonance revealed high signal intensity on T1-weighted images and hypo-intense rim on T2-weighted images. Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of Angiomatous Antrochoanal polyp. Incisional biopsy does help if the clinician suspects a malignant lesion. Complete removal is treatment of choice for Angiomatous Antrochoanal polyp.

Radicality of maxillary sinus surgery and size of the maxillary sinus ostium

Until the 1990s, radical sinus surgery was considered astandard procedure for maxillary sinus diseases, but it is no longer favored due to the high morbidity. Today, functional endoscopic sinus surgery (FESS) is considered the gold standard in sinus surgery. Modifications of surgical approaches also allow access to regions of the maxillary sinus that were previously difficult to reach. Depending on anatomy and pathology, different methods for widening the maxillary ostium can be selected. In typeI sinusotomy, the natural ostium is widened dorsally by amaximum of 1 cm. Sinusotomy typeII involves widening the natural ostium up to amaximum diameter of 2 cm. In sinusotomy typeIII, the natural ostium is widened dorsally to the posterior wall of the maxillary sinus and caudally to the base of the inferior turbinate. Beside the prelacrimal approach, more invasive approaches are the medial maxillectomy, in which the dorsal part of the inferior turbinate and the adjacent medial wall of the maxillary sinus is resected, as well as its modifications "mega antrostomy" and "extended maxillary antrostomy." Correct selection of the size of the maxillary sinus window is prerequisite for successful treatment and long-term postoperative success. Isolated purulent maxillary sinusitis can usually be treated by atypeI sinusotomy. Sinusotomy typeII addresses nasal polyps with involvement of the mucosa of the ostium, recurrent stenosis after previous surgery, chronic maxillary sinusitis due to cystic fibrosis, and purulent maxillary sinusitis with involvement of other adjacent sinuses. Sinusotomy typeIII is required for choanal polyps with attachment to the floor of the maxillary sinus, for extensive polyposis and fungal sinusitis, and for inverted papilloma. Particularly for (recurrent) disease and extensive interventions in the maxillary sinus, medial maxillectomy or a modification thereof may be required.

Computed tomographic scan utilization in the diagnosis of otorhinolaryngological diseases

Background: Having an audit of common otorhinolaryngological diseases diagnosed on computed tomography (CT) scan in our environment is important as it will help elucidate the sociodemographics and pattern of referral for CT scan from an ear, nose, and throat (ENT) clinic as well as CT findings. Materials and Methods: The request forms as well as the CT scan reports of 203 patients who were referred from the ENT clinic between 2006 and 2014 and had CT scan were retrieved from our records. All CT scans were done using a four-slice BrightSpeed helical GE CT scan machine. Out of the 214 patients recruited for this study, only 203 patients were unanimously agreed upon by the authors as the remaining 11 patients had incomplete data. Results: There were 124 males (61.1%) and 79 females (38.9%). The mean age of patients with nasopharyngeal tumor was 40.67 ± 26.01 years, laryngeal tumor was 57.47 ± 15.64 years, antrochoanal carcinoma was 46.05 ± 22.95 years, and sinusitis was 44.96 ± 17.19 years, while that of otitis media was 43.33 ± 23.60 years. A total of 177 patients representing 87.2% of the study population had one or two pathological findings on CT scan. Sinusitis accounted for most findings on CT scan (12.8%), followed by laryngeal tumor (10.7%) and antrochoanal carcinoma (10.2%). Others were choanal polyp (9.7%), nasopharyngeal tumors (9.2%), rhinitis (6.1%), mastoiditis (5.1%), and mucocele of the sinuses (4.6%). Juvenile angiofibroma (1.0%) and palatal masses (1.0%) were the least in terms of occurrence of all ENT conditions. Conclusion: Common findings on CT scan of the ENT in our environment have been documented.

A Rare Presentation of Central Giant Cell Granuloma of the Maxillary Sinus

Central giant cell granuloma (CGCG), also known as giant cell reparative granuloma, is a non-cancerous proliferative lesion of unknown etiology. It is a localized osteolytic lesion with the diverse biological behavior of aggression which most commonly affects the mandible and other jaw bones. It is a rare condition and its characteristic clinical or radiological features are still not well defined. It resembles to some neoplasms and can easily be misdiagnosed with Antro- Choanal Polyp, Angiofibroma, Squamous Cell Carcinoma and inverted Cell papilloma.We are reporting a case of rare presentation of CGCG arising from the maxillary sinus. This is a case report of a 15 year old boy who presented with the episodes of recurrent epistaxis and nasal obstruction. Diagnosis of giant cell granuloma was made on the basis of age presentation, rare location, and histological findings of excised specimen, which revealed central giant cell granuloma. This case helps to demonstrate the wide variation in the clinical and radiological features of CGCG and highlights the significance of histological features of this lesion.

THE GIANT INVERTED PAPILLOMA SCHNEIDER WITH GERMINATION IN THE ACNE SINUSES AND NASOPHARYNX

Inverted transitional cell papilloma (Schneider papilloma), a rare benign tumor, accounts for about 0.5 % of all neoplasms of the nose. Usually unilateral, recurrences of the tumor can occur after 5-10 years. In about 5% of patients, an inverted transitional cell papilloma is able to turn into cancer after a long-term benign course. These tumors have a destructive growth, recur and malignize. The article presents a case from clinical practice. The patient was admitted with a diagnosis of right-sided chronic polypous sinusitis. On examination, the right half of the nose is filled with polypoid formations, and in the posterior rhinoscopy, formations similar to a giant choanal polyp are determined. The peculiarity of education in the nasopharynx was hilly, lobed surface, so it was decided to carry out nasopharyngeal endoscopy through the left half of the nose for better visualization and taking a biopsy. The result of histological examination is an inverted transitional cell papilloma. The patient underwent a CT scan of the paranasal sinuses: the right half of the nasal cavity is filled with a soft tissue density mass formation, which prolapses into the right maxillary sinus, and is accompanied by the destruction of bone trabeculae and protrusion of the labyrinth walls and fills the right frontal sinus. Under intravenous combined anesthesia with tracheal intubation, a sinus surgery was performed according to Denker. Tumor formation removed as a single unit. The right half of the nose, the cavity of the maxillary and ethmoid sinuses and nasopharynx form a single cavity. There were no complications during the operation. Remote tumor was sent for histopathological examination. The result of histopathological examination of a remote tumor is an inverted papilloma. The peculiarity of this clinical case is the rarity of the pathology, the gigantic size of the neoplasm, the germination of the inverted papilloma in the maxillary, ethmoid sinuses and nasopharynx, removal of the neoplasm as a single unit, minimal blood loss during the operation, the absence of complications.

Nasal obstruction due to septochoanal polyp with bone metaplasia: Case report

In this study we describe the case of a patient with a choanal polyp that was implanted in the posterior sector of the nasal septum and spread and occupy the entire rhinopharynx. It was resected by an endonasal approach with endoscopes and extracted by mouth. In the computed tomography, areas of hyperdensity were identified, which in the histopathological study were diagnosed as mature bone trabeculae (bone metaplasia). Seven cases of septochoanal polyps were found in the literature review and only two with bone metaplasia.

Clinical research on surgical treatment of benign lesions in maxillary sinus by modified prelacrimal duct recess approach

Objective:To explore the clinical effects, surgical procedure and indications of surgical treatment for benign lesions in maxillary sinus through modified prelacrimal duct recess approach. Method:All 21 patients in this study who diagnosed with benign lesions in maxillary sinus, received routine preoperational exam and underwent endoscopic maxillary sinus surgery through modified prelacrimal duct recess approach. Postoperatively patients received routine medical treatment, and regular follow-up for average 11.3 months(from 3 months to 16 months). Result:Among 21 patients, there were 9 cases diagnosed with maxillary sinus cyst, 6 cases diagnosed with maxillary sinus choanal polyps, and 5 cases diagnosed with maxillary sinus hemorrhagic and necrotic polyps, 1 case of maxillary sinus root cyst. During the operation, the roots of maxillary sinus cyst or polyps were found in anterior or inferior wall of maxillary sinus. All patients recovered very well without recurrence. Conclusion:Modified prelacrimal duct recess approach appears to be a safe and effective method to resect benign lesions in the maxillary sinus, especially when lesions involved in anterior and inferior wall of the maxillary sinus.

Choanal polyp originating from the middle turbinate: A case report

Choanal polyps are most frequently sinusal in origin and a great majority of them are in the form of antrachoanal polyps. Apart from that, atypical localization sites including the superior turbinate, septum, cribriform plate have rarely been reported. Cases of choanal polyps originating in the middle turbinate are very rare. This paper reports a concha-choanal polyp case originating from the middle turninate, which was excised via endoscopic surgical technique, in the light of clinical and radiological findings.

Choanal polyps in children and adults: 10-year experience from a tertiary care hospital.

Choanal polyps (CPs) are benign, solitary, soft-tissue lesions extending towards the junction between the nasal cavity and the nasopharynx through the choana. The aim of this retrospective study was to evaluate clinical and histological characteristics of CPs in children comparing to adult patients. Characteristics of CPs treated in our hospital (demography, main complaints, side, localization, surgical approach, histological characteristics, accompanying paranasal sinus diseases, association with allergic rhinitis, postoperative follow-up period, and recurrence rates) were retrospectively reviewed. Seventy-eight patients with CPs were included, 22 (28%) patients in children and 56 (72%) patients in adults. We found no differences in the prevalence of main nasal complaints (nasal obstruction, rhinorrhea, snoring, and epistaxis) between the child and adult. In 27% children and in 7% adults, we found the oropharyngeal extension of CPs (p < 0.01). In 18% children and in 5.3% adults, we found the histological characteristics of an angiomatous CP (p < 0.05). The association with allergic rhinitis was more frequent in children (32%) than in adults (18%) (p < 0.05). In 32% pediatric patients and in 14% adult patients, we found the association with ipsilateral chronic maxillary rhinosinusitis without nasal polyps (CRSsNP) (p < 0.05). After the surgical treatment, we found the recurrence in 3 (14%) pediatric and in 5 (8%) adult patients, without the significant difference. Our results suggest some specificities of CPs in children comparing to adults. Oropharyngeal extension, association with allergic rhinitis and ipsilateral CRS, and the presence of angiomatous histological type of CPs are more frequent in the pediatric population.