Treatment Of Antrochoanal Polyps Research Articles

Evaluation and management of antrochoanal polyps in children

Abstract BACKGROUND. Antrochoanal polyps (ACP) were originally reported by Gustav Killian in 1906. Antrochoanal polyps (ACPs) are benign polypoid lesions that begin in the maxillary antrum and extend into the choana. Although there have been recorded occurrences of bilateral ACPs in the literature, ACPs are mostly unilateral. They typically have an impact on youth and youngsters. MATERIAL AND METHODS. In a trial of 15 cases treated and admitted to our ENT Pediatric Department at the Emergency County Hospital Timisoara over the previous four years, the pathology, differential diagnosis, treatment, complications, etiopathogenesis, clinical features, positive and differential diagnosis, preoperative evaluation, pathology, and treatment of ACPs were reviewed in this study. RESULTS. The patients age group comprised five females (33.33%) and ten boys (66.67%), ranging in age from 7 to 16 years. The most common presenting symptoms were unilateral nasal obstruction (100%), purulent rhinorrhea (66.67%), olfactory impairment (53.33%), and mouth breathing (46.67%). A nasal endoscopy and a craniofacial CT scan were the gold standards for diagnosing ACP. The chosen course of treatment for all pediatric patients included in the study was surgery: 12 patients (80%) underwent transnasal endoscopic polypectomy, and 3 patients (20%) underwent both transnasal polypectomy and transcanine fossa approach. The success rate of the combined endoscopic and transcanine fossa approach was 100%, whereas the transnasal endoscopic surgery (polypectomy) had an 80% success rate. CONCLUSION. Polypectomy combined with a transcanine fossa approach technique and transnasal polypectomy is the optimal course of treatment.

Bilateral antrochoanal polyp: a rare entity

Antrochoanal polyps (ACPs) are benign polyps that arises from inflamed and edematous mucosa of maxillary antrum. They arise most commonly from posterior wall of maxillary sinus. They occur more commonly in children and young adults without any sex predilection. The etiopathogenesis of ACPs is not clear but chronic sinusitis and allergy have been implicated. Patient usually present with nasal obstruction, may also have symptoms of epistaxis, rhinorrhoea, foreign body sensation. The diagnosis of the disease is done based on endoscopic examination of nasal cavities, computed tomography (CT) scan findings, and histopathologic results. ACPs are usually unilateral but can be bilateral in extremely rare cases. Based on adequate history and clinico-radiological examination misdiagnosis can be avoided which may lead to no improvement of symptoms and mandating revision surgery. Treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS is safe and effective method. Treating surgeon should focus on detecting the exact origin and extent of polyp to prevent recurrence. We herein presented extremely rare case of bilateral ACP in a 46 years female.

Antrochoanal polyp among children: A review

Abstract Antrochoanal polyp (ACP) or Killian polyp originates from the inflamed and edematous mucosa of the maxillary sinus. The etiopathogenesis of the ACPs is not clear. It has two components such as antral one which is always cystic and the nasal part is solid. The expanded intramural cyst enlarges to the point that it completely occupies the maxillary sinus, emerging through the natural ostium into the nasal cavity and extending towards the choana. The common clinical presentations are nasal obstruction and nasal discharge. Diagnostic nasal endoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI)are needed for making the diagnosis and the treatment planning. Surgery is indicated for the treatment of ACP. The endoscopic technique consists of an uncinectomy and resection of the polyp and its attachment to the maxillary sinus via a wide middle meatal antrostomy. Endoscopic sinus surgery via middle meatal antrostomy combined with trans-canine sinuscopy ensures the complete removal of the antral part of the ACP in children. The use of a microdebrider through the canine fossa is helpful to resect a broad attachment of the ACP in the maxillary sinus and it may be indicated as complementary to endoscopic sinus surgery. Simple avulsion of the ACP has a high chance of recurrence, whereas the Caldwell Luc procedure is associated with damage to the maxillary and dental growth centers. More research is needed for establishing the exact etiopathology and newer treatment options for ACPs.

Endoscopic medial maxillectomy for antrochoanal polyp

Antrochoanal polyp (ACP) are benign lesions that originate from the mucosa of the maxillary sinus, and extend into the nasal cavity to reach the choana and nasopharynx. The treatment of ACP is surgical, endoscopic medial maxillectomy (EMM) is one of the options for surgical therapy. ACP generally affects adolescents but in this case by adults. To report and analyze ACP in adult patient with EMM technique. A 45-year-old man with an ACP completely removed by EMM technique. The evidence-based literature regarding the ACP, their management, and its complications were conducted on the Pubmed Medline, PMC and Google Scholar database. Based on the inclusion and exclusion criteria, two studies were found relevant to our case. From sources in two journals, both are retrospective studies with the ACP completely removed with endoscopic medial maxillectomy technique and the other is a retrospective descriptive study. Complete ACP removal with the EMM technique. There was no complications during and after surgery and we had no recurrences during the control period.

Bilateral antrochoanal polyp: case report, literature review and clinical guidelines

Antrochoanal polyps are unilateral benign lesions that arise within the maxillary sinus antrum. The purpose of this study was to review the clinical characteristics and treatment of antrochoanal polyp (ACP). A retrospective analysis was performed to investigate the case of one patient with an extremely rare bilateral polyp with a high incidence of recurrence. ACPs account for approximately one-third of polyps occurring in children. Most of them are unilateral. The recurrent course of ACP is more prevalent in the paediatric population than in adults. ACPs require differential diagnosis with malignancies. The mainstay of treatment is surgery. The gold standard is endoscopic sinus surgery with complete removal of polyp mass under endoscopic control and widening of the maxillary sinus ostium via the middle meatus. Postoperative follow-up of at least 2 years is very important to monitor patients for recurrence.

Endoscopic management of antrochoanal polyps: a single UK centre's experience.

Antrochoanal polyps (ACPs) are benign lesions that originate from the mucosa of the maxillary sinus, and extend into the nasal cavity to reach the choana and nasopharynx. The treatment of ACPs is surgical, with a number of different surgical techniques having been described. We describe the first case series of ACPs from the UK and the endoscopic surgical technique that we have employed. A retrospective case note review of patients with ACPs managed under the care of the senior author was conducted. Demographic and clinical data for all patients were reviewed. The main outcome parameter measured was any sign of recurrence. A total of 29 consecutive patients were included for analysis from a 5-year study period, with 19 males and 10 females, and a mean age of 37.4 ± 13.6 years. Four patients within our group were referred to us with recurrent ACPs for revision surgery. All patients underwent surgery via the same endoscopic technique. The mean follow-up period was 14.7 ± 16.9 months, with an average follow-up of 22.5 months for the four revision cases. There were no recurrences in any of our patients. We describe the first reported series of endoscopic sinus surgery for antrochoanal polyps in the UK, and the largest worldwide series described for endoscopic management of ACPs in adults. We have had no recurrent cases, with a mean follow-up period of 14.7 months.

Variable extent of nasoantral window for resection of antrochoanal polyp: selection of the optimum endoscopic approach.

The aim of this study is to evaluate the long-term results of endoscopic sinus surgery in the treatment of antrochoanal polyps and the role of extending the middle meatal antrostomy on the expense of the inferior meatus in providing wide exposure and accessibility within the maxillary sinus to ensure complete removal of its antral portion. Thirty-six patients were reviewed. Two groups were identified: Group A including patients with antrochoanal polyps that were resected endoscopically through a classical wide middle meatal antrostomy and Group B which included those who underwent endoscopic removal via an extension of the antrostomy inferiorly through submucosal resection of the lateral bony skeleton of the inferior meatus. There were 13 female and 23 male patients with a mean age of 28 ± 9.4 years. The mean follow-up period was 20.4 ± 6.7 months. Six patients were recurrent after previous endoscopic surgery. Group A included 17 patients and the remaining 19 patients were assigned to Group B. Two patients from Group A developed symptomatic recurrence and were cured with revision extended antrostomy. Three patients showed endoscopic evidence of a developing cystic lesion within the maxillary sinus that was punctured through the wide antrostomy. Endoscopic resection is considered the main treatment modality of antrochoanal polyps. Modification of the technique through removal of the lateral bony skeleton of the inferior meatus with downward displacement of the inferior turbinate provided accessibility to the inferior and prelacrimal recesses of the maxillary sinus.

Evaluation and Management of Antrochoanal Polyps

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.

Changes in the Maxillary Sinus Volume and the Surgical Outcome after the Canine Fossa Puncture Approach in Pediatric Patients with an Antrochoanal Polyp: Results of a Minimum 3-Year Follow-Up

An antrochoanal polyp (ACP) originates from the maxillary antrum and simple excision results in high recurrence rates. Canine fossa puncture (CFP) has been proposed as an alternative method of accessing the entire maxillary antrum. To investigate the long-term effects of the CFP approach on changes in the maxillary sinus volume in pediatric patients with an ACP, we compared the sinus volume on the operated and normal sides, using preoperative computed tomography (CT), and postoperative CT performed at least 3 years after the procedure. The surgical outcomes were also assessed using endoscopic and CT findings. Seven patients met the inclusion criteria and the ACP was removed via the CFP approach. After a mean follow-up period of 43.9 months, we compared the changes in the maxillary sinus volume between the operated and normal sides, using the pre- and postoperative CT data. No contractures or decrease in the maxillary sinus volume on the diseased side were observed in any of the patients on postoperative CT, and the average volume of both maxillary sinuses was greater on postoperative CT compared with the preoperative scans. None of the patients showed evidence of recurrence on the endoscopic and CT examinations. CFP did not affect the maxillary sinus volume in pediatric patients with an ACP and led to a successful surgical outcome in all of the patients. Based on these results, we recommend CFP as a safe, effective method for the treatment of ACP.

Polipectomia endoscópica com meatotomia média como tratamento de pólipo antrocoanal

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%) do sexo feminino e 12 (41,4%) 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%), respiração oral, 11 (37,9%), roncos, 9 (31%), rinorréia, 5 (17%), epistaxe, 2 (6,9%), cefaléia, 2 (6,9%) e gotejamento, 1(3,4%). A associação com atopia foi de 9 (31%). A média de seguimento foi de 17 meses (3-63 meses). Apenas 2 pacientes (6,9%) apresentaram recidiva. CONCLUSÃO: O índice de recidiva obtido por nosso trabalho não difere dos dados da literatura, mesmo quando comparado com procedimentos longamente estabelecidos.

Endoscopic Polipectomy with Middle Meatal Antrostomy for Antrochoanal Polyp Treatment

SummaryAntrochoanal 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%) were females and 12(41.4%) males, age range, 7-75 years (average of 27.55years) were included in this study. The main symptom were nasal obstruction 24(82%), oral breathing 11(37.9%), snoring nine (31%), rhinorrhea 5(17%), epistaxis 2(6.9%), headache 2(6.9%), and drip one (3.4%). The association with atopy was found in nine (31%). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9%) 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.

Endoscopic sinus surgery for antrochoanal polyps in children

The antrochoanal polyp (ACP) occurs predominantly in children and young adults. Endoscopic surgery is effective for the treatment of ACPs in adults; however, articles discussing the treatment in pediatric patients are rare. The purpose of this study was to evaluate the outcome of endoscopic treatment of ACPs in children. Between January 1998 and February 2004, 26 children were prospectively enrolled in this study. Completely removing the base of the ACPs was achieved through transnasal endoscopic (TE) or combined endoscopic and transcanine (CET) approach. The CET approach was used in ACPs originated from the lateral wall of antrum. All patients received CT scan 1 year after surgery to evaluate the outcome of surgery. Most of the ACPs were multitudinous and the distributions of the ACPs' origin in the maxillary sinus were as follows: posterior wall (92.3%), lateral wall (61.5%), and inferior wall (38.5). The success rate was 76.9% in the TE approach and 100% in the CET approach. Three in the TE approach recurred and all of them had concomitant rhinosinusitis. All three patients were cured in the revision CET operations. No major complications occurred. Endoscopic treatment of ACPs in children is safe and effective. Early diagnosis and treatment of ACPs is important because secondary rhinosinusitis can make the disease complicated and the surgeries difficult.

P174: FESS and Caldwell-Luc as Treatment of Antrochoanal Polyps

P174: FESS and Caldwell-Luc as Treatment of Antrochoanal Polyps

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.