© Borgis - New Medicine 3/1999, s. 26-27
Michał Grzegorowski, Jarosław Antyborzec, Jarosław Szydłowski, Iwona Steiner, Joanna Zabel-Olejnik, Grzegorz Wonicki
Antral choanal polyps in the records of the ent department of the Pediatric Institute of the Karol Marcinkowski University of Medical Sciences in Poznań, Poland
ENT Department of Pediatric Institute of the Karol Marcinkowski University of Medical Sciences in Poznań, Poland
Head: Prof. Michał Grzegorowski, M.D.
Single unilateral polyp, so-called antral choanal polyp, constitutes about 5% of nasal polyps. It is usually found among children and teenagers. Authors, describe experience in treatment of the disease, on the basis of 26 cases.
The nasal polyps occur as pedunculated lesions covered by thin mucous membrane containing a small number of lymphocytes and eosinophils, and filled with gelatinous connective tissue. They are most frequently located in the upper part of the lateral nasal wall around the middle turbinate. Nasal polyps as multiple lesions occur mostly among adults and teenagers over 14 years old. Single, unilateral polyp, so-called antral choanal polyp (ACP) comprises about 5% of nasal polyps, and occurs primarily among children and teenagers (1, 2). It contains a large amount of fibrous elements and may be considered as a tumour rather than a polyp (2). The origin of ACP is the mucous membrane of the maxillary sinus, but there have been cases describing the point of origin in the sphenoid sinus, ethmoid, and middle turbinate (3, 4). When increasing in size it extends through the semilunar hiatus into the middle meatus and elongates to the nasopharynx. Because of the ostial constriction it has two parts - one in the sinus, and the second in the nasal cavity, connected by a narrow junction. One paper reported a case of herniation of the ACP through an oroantral fistula to the oral cavity after extraction of the upper molar. ACP, much more prevalent in the paediatric population, needs special consideration because its clinical manifestations may be mimicked by conditions such as juvenile angiofibroma, meningoencephalocele, and teratoma (1). Contrary to bilateral nasal polyposis (BNP), mostly associated with allergy, where glucocorticoids and antibiotics play a dominant role in therapy (5), ACP requires surgical therapy. According to Goldman, intranasal polypectomy is not sufficient and carries a risk of recurrence (2). Antrostomy or Caldwell-Luc with extirpation of the polyp stalk is the best method to avoid recurrence.
Purpose of study
The purpose of this study was to estimate the recurrence of ACP among children treated in the ENT Department of the Pediatric Institute by internasal polypectomy or extirpation of a polyp via the oral cavity. No Caldwell-Luc was performed because of children´s age contra-indicating this kind of operation. We also decided to measure the prevalence of ACP among children.
Material and method
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1. Chen J.M. et al.: Antro-coanal polyp: a 10-year retrospective study in the pediatric population with a review of the literature. J. Otolaryngol. 1989 Jun, 18(4), 168-72. 2. Goldman J.L.: The principles and practice of rhinology. A Wiley Medical Publication, John Wiley and sons. 1987. 3. Ileri F. et al.: Clinical presentation of a sphenochoanal polyp. Eur. Arch. Otorhinolaryngol., 1998, 255:3, 138-9. 4. Lopatin A. et al.: Choanal polyps: one entity, one surgical approach? Rhinology, 1997 Jun, 35:2, 79-83. 5. Reiss M.: Current aspects of diagnosis and therapy of nasal polyposis. Wien Klin. Wochenschr. 1997 Oct, 109:20, 820-5. 6. Takeda Y.: Herniation of an antral polyp through an oroantral fistula. Ann. Dent. 1992, 51(2): 26-8.