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.
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To investigate the length of follow-up needed to detect recurrence of antrochoanal polyps. A retrospective investigation was performed on patients who had been operated on with a preoperative diagnosis of antrochoanal polyps in Chiang Mai University hospital from to Results and Discussion.
The median age was Eighteen patients were male The origin of choanal polyps was the maxillary antrum in 32 patients. The most common symptom was nasal obstruction The surgical procedures were polypectomy in one child and combined endoscopic and transcanine fossa approach in two adults. The remainder of the patients underwent endoscopic removal of the polyps.
The follow-up time ranged from 1 day to 8 years. There were 5 cases of recurrence of which four were in children. The time for recurrence was 1. Antrochoanal polyps are more common in younger patients. Recurrence was significantly higher in children. The condition of antrochoanal polyps Killian polyps is a distinctive clinical disease. It is characterized by polyps originating from the maxillary antrum, which then extend through the natural or accessory ostium into the nasal cavity, choana, and nasopharynx.
The maxillary portion is cystic though there are some reports of solid forms polyps , while nasal and choanal portions are usually solid [ 1 ]. Choanal polyps may come from the sphenoid sinus, the nasal septum, and other parts of the nasal cavity [ 2 — 4 ].
The most common presenting symptom is nasal obstruction, either unilateral or bilateral. Other complaints are rhinorrhea, sinusitis, snoring, dysphagia, and so forth. Complete surgical removal of the nasal and antral portion of the polyp is the standard treatment to prevent recurrence.
However, in some patients with a small maxillary sinus or in revision cases, the origin of the polyp could not be well identified. This study is to investigate the length of follow-up needed to detect recurrence of polyps in patients.
The authors also would like to discern if there are differences in recurrence between children and adults. A retrospective investigation was carried out on patients who had been operated on with a preoperative diagnosis of antrochoanal polyps in Chiang Mai University hospital from to After excluding 6 cases of inverted papilloma and 1 case of maxillary mucopyocele, 38 cases of patients with choanal polyps were included in this study.
Clinical data and operative findings were reviewed, and the latest follow-up data were collected. Delayed diagnosis was defined as treating patients with another diagnosis such as sinusitis or allergic rhinitis for more than 3 visits to the outpatient document without recording incidence of polyps.
The treatment of antrochoanal polyps was complete surgical removal with either an endoscopic approach alone or an endoscopic approach combined with the transcanine fossa approach. The exact probability test was used for the proportion of the investigative variables between the age groups, and survival analysis was used for evaluating the potential factors affecting recurrence.
There was no statistical difference in the sex of the age groups Table 1. The other polyps originated from the superior turbinate or sphenoethmoidal recess, totaling 6 adult patients. Positional changing of the obstruction in the supine or lateral decubitus was found in 9 patients One adult patient who presented with a sore throat and a mass in the oropharynx for 3 days had no nasal obstruction at all.
The duration of symptoms ranged from 3 days to 4. When comparing between age groups, the symptoms showed no significant difference. However, purulent rhinorrhea was more common in children Delayed diagnosis was more common in adults The remainder of the patients underwent endoscopic removal of the polyps by a middle meatus antrostomy with an operative note of incomplete removal of the maxillary part in the case of one child.
All but one polyp extended into the nasal cavity through the middle meatus, via either natural or accessory ostium. Only one case differed in the children, where the polyp extended through the inferior meatus Figure 1.
The follow-up time ranged from 1 day to 8 years, the median being 1. Two patients failed to keep appointments for the postoperative care that was scheduled.
The case of recurrence in an adult was where the surgery had been carried out in another hospital. After the recurrence a revision was carried out at CMU and no further recurrence occurred in the one-year follow-up period. The origin of the polyps from all recurrent cases was from the maxillary sinus, while none of sphenoethmoidal polyps recurred.
The sex, age group, and infection were tested as risk parameters for recurrence. The origin of polyps and type of surgical procedure were not tested because of the limited numbers of patients in each subgroup Table 2. The polyps recurred significantly more in the group of children when compared to that of the adults.
Antrochoanal polyps have been known about for some time; for example, in a polyp from the antrum of Highmore was mentioned by Fredrik Ruysch.
Antrochoanal polyps ACP are also known as Killian polyps after Gustav Killian, the doctor who stressed this special type of polyp from the maxillary antrum to choana in [ 1 ]. Though the pathogenesis is still unknown, Berg et al. Frosini et al. Mostafa et al. Mostaf et al. Antrochoanal polyps were found in patients with a wide age range from 5 to 81 years [ 1 , 3 , 9 ]. The patients in this study ranged from 7 to 64 years of age. The median age of 21 years showed that this type of polyp was more common in the younger age group as was found in many previous studies [ 1 , 10 — 12 ].
Other studies found that the ACP occurred more commonly in males, but this was not found to be the case in this study. When comparing the clinical presentations and the outcome of treatment in children and adults, there was no statistical significant difference in clinical presentations though infection was more common in the younger age group.
The key of successful treatment is complete removal of the polyp from the maxillary origin. The inflammatory mucosa of sinusitis was mentioned as a possible risk of recurrence in some studies as it led to difficulty in identifying the origin in the antrum [ 9 , 13 ]. The polyps originating from the lateral, anterior, and inferior walls of the maxillary antrum were difficult to view and remove with the transnasal endoscopic approach alone [ 9 — 11 ].
Special instruments or a combined transcanine fossa approach may be needed to complete surgical removal [ 9 , 11 , 14 — 16 ]. The choanal polyps which originated from the superior turbinate or the sphenoethmoidal recess showed no recurrence. This type of polyp might be different from those developing from the maxillary antrum and is easier to locate and remove from its origin. No other types of choanal polyps in children were found, though several have been reported in other studies [ 17 , 18 ].
In other studies, the occasion of recurrence was found as early as 6 months in the cases of incomplete removal [ 10 ] to as long as 3 years [ 3 ].
Ten percent of our patients did not come back for postoperative evaluation as they lived very far away or came from neighboring countries. In this group of patients, the postoperative cleaning was carried out before discharge to ensure sinus drainage was adequate. The median follow-up time was 1. The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors would like to thank Ms. Chidchanok Ruengorn, Ph. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We will be providing unlimited waivers of publication charges for accepted articles related to COVID Sign up here as a reviewer to help fast-track new submissions.
Journal overview. Special Issues. Academic Editor: David W. Received 30 Jun Accepted 21 Jul Published 03 Aug Abstract Objective. Introduction The condition of antrochoanal polyps Killian polyps is a distinctive clinical disease. Materials and Methods A retrospective investigation was carried out on patients who had been operated on with a preoperative diagnosis of antrochoanal polyps in Chiang Mai University hospital from to Table 1.
Figure 1. Table 2. References P. Frosini, G. Picarella, and E. Aydin, G. Keskin, E. Kizil, U. Aydil, A. Ceylan, S. Uslu, V. Lessa, R.
Table of Contents
Antrochoanal polyps ACP are benign lesions that arise from the mucosa of the maxillary sinus, grow into the maxillary sinus and reach the choana, and nasal obstruction being their main symptom. It is an interesting model to compare the pathophysiological mechanisms with those of bilateral nasal polyposis NP. There is a lack of research in some areas of ACP, which have to become the main aims for future investigations of this disease. Macroscopically, they have a cystic intramaxillary portion and a solid intranasal portion. Microscopically, they are similar to a maxillary cyst of the mucosa. Nasal endoscopy, computed tomography and magnetic resonance are the main diagnostic techniques.
Cancer Prevention & Current Research
Her parents reported that she had been snoring while sleeping. Upon examining her pharynx, a 1 cm purple, cobblestoned mass with white exudate was visible in the posterior pharynx and the uvula was displaced to the left. The mass appeared to originate from the nasopharynx, and its inferior aspect was at the level of the epiglottis. Based on the initial symptoms, an airway radiograph was obtained. The radiograph showed a large polypoid mass obstructing the right nasal cavity, the nasopharynx, and extending to the epiglottis Figure 1.
Antrochoanal Polyps: How Long Should Follow-Up Be after Surgery?
Antrochoanal polyps ACP are solitary sinonasal polyps that arise within the maxillary sinus. Similar, less common, polyps can arise in the sphenoid sinus extending into the nasopharynx : these are termed sphenochoanal polyps. Likewise, there are nasochoanal, frontochoanal, and ethmochoanal polyps 9. They are most commonly seen in young adults in their 3 rd to 5 th decades.