© Borgis - New Medicine 4/2011, s. 111-112
*Lechosław P. Chmielik, Teresa Ryczer, Mieczysław Chmielik
The clinical analysis of antrochoanal polyps in children
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Introduction. Antrochoanal polyps (ACPs) occur most commonly in children and young adults. Antrochoanal polyps are associated with chronic sinusitis and/or allergy. The symptoms of ACPs are nasal obstruction, rhinorrhea, headaches and post-nasal drip. The treatment of choice is surgical.
Material and methods. In the study we analyzed the clinical data of 19 children with antrochoanal polyps who were treated in the Department of Pediatric Otolaryngology of Medical University of Warsaw from January 2005 to January 2011. We analyzed demographic characteristics, the localization of antrochoanal polyps, clinical symptoms and applied treatment.
Conclusions. Most patients with antrochoanal polyps have a history of chronic sinusitis and/or allergy. The dominating symptoms in children with ACPs are nasal obstruction and chronic rhinorrhea. Computed tomography is an important radiological examination of choice for evaluation of antrochoanal polyps. Functional endoscopic sinus surgery (FESS) with polypectomy has been the dominating surgical approach.
Antrochoanal polyps originate from the inner wall of maxillary sinus, pass through the natural sinus ostia and/or assesory ostia, that are formed due to the destruction of the medial sinus wall, and extend into the choanae to the nasopharynx or oropharynx (4, 10). They occur most commonly in children and young adults.
Antrochoanal polyps represent 3 to 6% of all nasal polyps (4,1), however in children APCs may represent even 33% of all nasal polyps (2). ACPs are usually unilateral, although there are some cases of bilateral ACPs reported (7, 8). Antrochoanal polyps are associated with chronic sinusitis and/or allergy. Careful history taking, physical ENT and paediatric examination, laboratory test results are the crucial elements of forming the diagnosis. Computed tomography of sinuses and nasopharynx is an important radiological examination of choice for evaluation of antrochoanal polyps.
The most common symptoms of ACP are nasal obstruction, rhinorrhea, headaches and post-nasal drip (1, 2, 4), but there may be also more severe symptoms such as epistaxis, dyspnea, dyshagia and weight loss (1, 2).
The differential diagnosis consists of juvenile angiofibroma, encephalocele, nasal glioma, mucocele, nasopharyngeal malignancies, retention cyst, enlarged adenoids and turbinates, inverted papilloma and nasal polyposis (1, 9, 10). The treatment of ACP is always surgical (1, 3). However, despite the surgical management antrochoanal polyps, tend to recur.
MATERIAL AND METHODS
The clinical analysis was performed retrospectively. The clinical data of 19 patients with antrochoanal polyps, who were treated in the Department of Pediatric Otolaryngology of Medical University of Warsaw from January 2005 to January 2011, were analyzed.
In the group of patients there were 19 children with antrochoanal polyps. There was a slight female predominance (F: 53 %, M: 47%). The mean age was 10 years old, with a range from 6 to 14 years old.
The most common symptoms were nasal obstruction (84%), followed by chronic rhinorrhea (63%). Quite frequent symptoms were snoring (32%), nocturnal sleep apnea (16%), recurrent upper respiratory tract infections (16%). Rarely the patients were complaining of headaches, cough, unilateral facial pain.
42% of the patients had a history of allergy. The patients were allergic to different allergic substances such as dust mites, grass, corn, fur of animals, acetylsalicylic acid, chemical substances, food. However, in our study we did not do additional allergic tests.
Antrochoanal polyps were mainly situated in the right nasal cavity – 74% (n = 14), whereas in the left nasal cavity they were present in 36% (n = 5).
All patients underwent surgical treatment. The antrochoanal polyps were removed under general anesthesia. In most patients also functional endoscopic sinus surgery (FESS) (84%) was performed at the same time. In 2 cases endoscopic ethmoidectomy was performed (11%), one patient had an endoscopic surgery of sphenoid sinuses. In 63% of the patients polyps of maxillary sinuses were reported intraoperatively, whereas polyps in nasal cavities in 25%. Post-operative follow up was carried out in ambulatory care.
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