Antrochonal and Enthmoidal Polypi

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Antrochonal and Enthmoidal Polypi

  • Bilateral Ethmoidal Polypi
  • Diseases associated with the formation of nasal polypi are:
    • Chronic rhinosinusitis.
    • Non-allergic rhinitis with eosinophilia syndrome (NARES)
    • Asthma.
    • Aspirin intolerance.
      • Sampter’s triad consists of (MCQ)
        • nasal polypi,
        • asthma
        • aspirin intolerance.
    • Cystic fibrosis.
    • Allergic fungal sinusitis
    • Kartagener’s syndrome.
      • consists of bronchiectasis sinusitis, situs inversus and ciliary dyskinesis.
    • Young’s syndrome
      • consists of sinopulmonary disease and azoospermia.
    • Churg-Strauss syndrome.
      • Consists of asthma, fever, eosinophilia, vasculitis and granuloma.
    • Nasal mastocytosis.
      • It is a form of chronic rhinitis in which nasal mucosa is infiltrated with mast cells but few eosinophils.
      • Skin tests for allergy and IgE levels are normal.
  • Treatment (MCQ)
    • Conservative
      • Early polypoidal changes with oedematous mucosa
        • Antihistaminics
        • control of allergy.
        • short course of steroids
    • Surgical
      • Polypectomy.
      • Intranasal ethmoidectomy.
        • Indication – polypi are multiple and sessile
        • they require uncapping of the ethmoidal air cells by intranasal route
      • Extranasal ethmoidectomy.
        • This is indicated when polypi recur after intranasal procedures and surgical landmarks are ill-defined due to previous surgery.
      • Transantral ethmoidectomy.
        • This is indicated when infection and polypoidal changes are also seen in the maxillary antrum.
        • In this case, antrum is opened by Caldwell-Luc approach and the ethmoid air cell approached through the medial wall of the antrum.
      • Endoscopic sinus surgery. (MCQ)
        • These days, ethmoidal polypi are removed by endoscopic sinus surgery more popularly called FESS (functional endoscopic sinus surgery).
    • Treatment Summary
      • One or two peduncalated polyps  – Polypectomy
      • Multiple and sessile polyp –  Intranasal ethmoidectomy
      • Recurrence of polyp after intranasal procedures –  Extranasal ethmoidectomy
      • Infection and polypoidal changes also seen in maxillary antrum-  Transantral ethmoidectomy
  • Antrochoanal Polyp
    • This polyp arises from the mucosa of maxillary antrum near its accessory ostium, comes out of it and grows in the choana and nasal cavity.
    • Nasal allergy coupled with sinus infection
    • seen in children and young adults.
    • Usually they are single and unilateral (MCQ)
    • Symptoms
      • Unilateral nasal obstruction is the presenting symptom.
      • Voice may become thick and dull due to hyponasality.
      • Nasal discharge, mostly mucoid
    • Signs
      • As the antrochoanal polyp grows posteriorly, it may be missed on anterior rhinoscopy.
      • Posterior rhinoscopy may reveal a globular mass filling the choana or the nasopharynx.

. Differences between antrochoanal and ethmoidal polypi

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Investigations

  • X-rays of paranasal sinuses
    • 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 is avoided
    • endoscopic sinus surgery has superceded other modes of polyp removal.

Important Points about  Nasal Polypi

      • If a polypus is red and fleshy, friable and has granular surface, especially in older patients, think of malignancy.
      • Simple nasal polyp may masquerade a malignancy underneath.
        • Hence all polypi should be subjected to histology.
      • A simple polyp in a child may be a glioma, an encephalocele or a meningoencephalocele.
        • It should always be aspirated and fluid examined for CSF.
        • Careless removal of such polyp would result in CSF rhinorrhoea and meningitis.
      • Multiple nasal polypi in children may be associated with mucoviscidosis.
      • Epistaxis and orbital symptoms associated with a polyp should always arouse the suspicion of malignancy.


Endoscopic Sinus Surgery for Antrochoanal polyp
Antrochoanal Polyp
his type of polyp originates in the maxillary antrum and comes to nasopharynx via the nasal cavity. The polyp can cause post nasal drip, nasal obstruction & headache . The treatment is surgical removal and most accepted and recent treatment is endoscopic removal.
Antrochoanal Polyp
Enhanced Coronal CT Scan of a right antrochoanal polyp
Coronal CT Scan of a right antrochoanal polyp arising from the right maxillary sinus and its path through the nasal cavity into the oropharynx. The polyp is highlighted in yellow. An isolated opacified ethmoid sinus is highlighted in red.
FESS – ANTROCHOANAL POLYPECTOMY
Huge Antrochoanal Polyp
The importance of appropriate nasal endoscopy and ENT evaluation is illustrated here. A 37 year old man was being treated with antibiotics and allergy medication for one year. Examination in my office revealed a huge polyp extending from his maxillary sinus into his nose and then wrapping around the back of the nose to the other side
ANTROCHOANAL POLYP NARROW PEDICLE
PRESENTED TO THE WORLD OF OTORHINOLARYNGOLOGY
Antrochoanal Polyp – Dr Vivek Sasindran (ENT Surgeon – Pushpagiri Medical College)
Pólipo Antrocoanal de Killian-Cirurgia Endoscópica-Antrochoanal Killian´s Polyp Endoscopic Removal