Antrochoanal Polyp

This polyp arises from the mucosa of max illary antrum
near its accessory ostium, comes out of it and grows in
the choana and nasal cavity. Thus it has three parts.
(a) Antral: which is a thin stalk.
(b) Choanal: which is round and globular.
(c) Nasal: which is flat from side to side.
Aetiology. Exact cause is unknown. Nasal allergy coupled
with sinus infection is incriminated. Antrochoanal
polypi are seen in children and young adults. Usually
they are single and unilateral.
Symptoms. Unilateral nasal obstruction is the presenting
symptom. Obstruction may become bilateral when
polyp grows into the nasopharynx and starts obstructing
the opposite choana. Voice may become thick and dull
due to hyponasality. Nasal discharge, mostly mucoid,
may be seen on one or both sid es.
Signs. As the antrochoanal polyp grows posteriorly,
it may be missed on anterior rhinoscopy. When large, a
smooth greyish mass covered with nasal discharge may be
seen. It is soft and can be moved up and down with a
probe. A large polyp may protrude from the nostril and
show a pink congested look on its exposed part. Posterior rhinoscopy
may reveal a globular mass filling the choana or the nasopharynx.
A large polyp may hang down behind the soft palate and present in the oropharynx.
Differential diagnosis
1. A blob of mucus often looks like a polypi but it would
disappear on blowing the nose.
2. Hypertrophied middle turbinate is differentiated by
its pink appearance and hard feel of bone on probe
testing.
3. Angiofibroma has history of profuse recurrent epistaxis.
It is firm in consistency and easily bleeds on probing.
4. Other neoplasms may be differentiated by theIr fleshy
pink appearance, friable nature and their tendency to
bleed.
X-rays of paranasal sinuses may show opacity of the
involved antrum. X-ray, (lateral view) soft tissue nasopharynx,
reveals a globular swelling in the postnasal space.
It is differentiated from angiofibroma by the presence of a
column of air behind the polyp.
Treatment. An antrochoanal polyp is easily removed
by avulsion either through the nasal or oral route. Recurrence
is uncommon after complete removal. In cases
which do recur, Caldwell-Luc operation may be required
to remove the polyp completely from the site of its origin
and to deal with co-existent maxillary sinusitis. These
days, endoscopic sinus surgery has superceded other modes
of polyp removal. Caldwell-Luc operation is avoided .