DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.

BILATERAL ANTROCHOANAL POLYP IN

AN ELDERLY MALE A RARITY
*Sandesh Chodankar **Markandeya Tiwari ***Nicola Barreto ****Ehrlson de
Sousa

ABSTRACT:
Antro-choanal polyps are generally recognized to
represent approximately 4-6% of all nasal
polyps and are more prevalent in the pediatric
population.1 Bilateral antro-chonal polyps are a rarity.
We report a case of bilateral an elderly male.

Address of Correspondence:
Dr. Ehrlson de Sousa

INTRODUCTION
Antro-Choanal Polyps are benign, solitary lesions
which arise from the mucosa of the Maxillary
sinus. The mucosa usually prolapses through the
maxillary ostium and may protrude through the
accessory ostium, if present. They increase in size and
gradually progress towards the choana and
nasopharynx and typically appear as a smooth, pale or
bluish solitary mass on anterior or posterior
rhinoscopy.

Junior Resident Department of ENT

Goa Medical College Bambolim
Goa- 403202
Mob: 9822920729
Email: ehrl218@gmail.com

An antrochonal polyp usually has 3 parts to it i.e

antral, nasal and choanal part. Antro-choanal polyps
are generally recognized to represent
approximately 4-6% of all nasal polyps and are more
prevalent in the pediatric population.1 Killian
2

was the first to describe this entity in 1906. It is nearly

always unilateral and bilateral. Antro-Choanal Polyp is
an extremely rare entity and seldom found in
4,5,6

literature.

was in a 24-year-old female while post-operative

bilateral ACP was documented emerging from
previously performed inferior meatus antrostomies in a
45-year-old female.
CASE REPORT
A 57-year-old known hypertensive male
presented to ENT OPD with history of bilateral
progressive nasal blockade for the last three years.
*Associate Professor, **Assistant Professor, ***Senior Resident, ****Junior Resident, Department of ENT, Goa Medical College, 51
Goa

Vol.-9, Issue-I, Jan-June - 2015

The oldest report of primary bilateral ACP

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

There was increase in intensity of symptoms for the last

3 months. There was no history of pain, itching,
sneezing, nasal bleeding or any nasal discharge. There
was no history of associated asthma or allergy.

CT scans revealed both maxillary sinuses filled

with hypo-dense soft tissue densities extending into the
corresponding nasal cavities and posteriorly upto the
choana. Osteomeatal complex was widened and
blocked on both sides.

General physical examination was within normal

limits.

The patient underwent Endoscopic sinus surgery

with bilateral uncinectomy, middle meatal antrostomy
and bilateral polypectomy under general anaesthesia

Anterior rhinoscopy revealed smooth, pale,

polypoidal masses filling up both nasal cavities.
Posterior rhinoscopy revealed the same polypoidal
masses at both choana.
Routine blood investigations were within normal
limits. Xray of the nose and paranasal sinuses showed
opacification/haziness of both maxillary antrum and
nasal cavities.

. The polyps were pale fleshy and had a glossy surface.

The gross appearance showed that the polyps had 3
parts: Antral, nasal and choanal.
The histopathologic report confirmed it to be
benign inflammatory nasal polyps.
DISCUSSION
Antrochoanal polyps (ACP) are thought to
represent

hypertrophic

maxillary

sinus mucosa

prolapsing into the nasal cavity through the natural or

accessory ostium. Although the natural history and site
of origin of ACP was first reported by Killian in 1906 ,
the first description of ACP was made by Palfyn in
1753. Antro-choanal polyps are almost always
unilateral and bilateral antrochoanal polyps are
extremely rare. Only 3 cases were found in literature3,6
with only one reported case in an adult.

Vol.-9, Issue-I, Jan-June - 2015

Fig 1: CT findings

The common clinical presentation of AntroChoanal Polyp is nasal obstruction, and it usually
presents as a hypo-attenuating mass occupying the
maxillary sinus on CT scans, which distinctly reveals
its extension.
No definite etiological factor has been found
but chronic sinusitis, cystic fibrosis and allergy may
have roles in its development. Look et al. postulated
that 24% of ACP had the aspirin-sensitive asthma
triad.

Fig 2: Intra operative picture of Bilateral AC polyp

52

The treatment is surgical. The aim of surgery is to

remove both the nasal and antral parts of the

DOI No.: 10.21176/ ojolhns.09745262.2015.09.1

polyp as it tends to recur after simple

avulsion.
The maxillary antrum should always
carefully inspected.

be

Different approaches are recommended for

this purpose, from the classical Caldwell-Luc
approach to the modified Caldwell-Luc
approach (intranasal antrostomy with resection
of anterior part of inferior turbinate) and
functional endoscopic sinus surgery (FESS). The
Caldwell-Luc procedure may have possible sideeffects including both anaesthesia and swelling

REFERENCES
1.

Chen JM, Schloss MD, Azouz ME .

Antrochoanal polyp: a 10 year
retrospective study in the paediatric
population with a review of the
literature. J Otolaryngol. 1989 June;
18(4):168-72.

2.

Fosini P, Picarella G, De Campora E.

Antrochoanal polyp: analysis of 200
cases. Acta OtolaryngologicaItalica.
2009 Feb; 29(1):21-26.

3.

Basu SK, Bandyopadhyay SN, Bora

H. Bilateral Antrochoanal polyps. J
Laryngol Otol. 2001Jul; 115 (7): 5612.

4.

Markov D, Drajina Z, Pole G. Nasal

polyps i n c h i l d r e n . A c t a M e d
C r o a t i c a . 1 9 9 9 ; 53(2):97-99.

5.

Chung SK, Chang BC, Dhong HJ.

of the cheek and also carries risks to the

developing teeth in children.
At present FESS is a very popular
technique
and if properly performed there is no
recurrence
and very few complications. Antro-choanal
polyps originating from the anterolateral wall
can be removed by a combined endoscopic and
trans-canine approach.

Surgical, radiologic and histologic

findings of Antrochoanal polyp. Am J

CONCLUSION
generally
mostly in
occurrence
a very rare

DISCLOSURES
(a) Competing interests/Interests of ConflictNone
(b) Sponsorships - None
(c) Funding - None

Rhinol. 2002 Mar-Apr;16(2):71-76.

6.

Yilmaz YF, Titiz A, Ozcan M, Tezer

MS, Ozlugedik S, Unal A. Bilateral
antrochoanal polyps in an adult: a case
report. B-ENT.2007; 3(2):97-9.

Vol.-9, Issue-I, Jan-June - 2015

Antrochoanal
polyps
are
unilateral in occurrence and seen
children and adolescents . Bilateral
of antrochoanal polyps in an adult is
occurrence.