Antrochoanal polyps are benign, large, inflammatory polyps which originate from within the maxillary sinus and extend through the natural or accessory ostia, into the nasal cavity, with extension into the choana. Proper clinical and radiologic evaluation should be done in such cases before . The antrochoanal polyp, usually a solitary benign growth, arises from the maxillary antrum of a nonatopic patient. 7 The maxillary masses that occur most frequently in children are mucoceles and mucopyoceles, which usually show a characteristic enhanced ring when intravenous contrast is administered. We described two cases of atypically giant antrochoanal polyps: in a 15-year-old child and in a 38-year-old man. Its physiopathology remains unclear. Further examination by nasal endoscopy, computerized tomography, and histopathological evaluation of the excised polyp have confirmed the diagnosis of an antrochoanal polyp. An oral examination revealed the . J Craniofac Surg 2015;26:e661-2. Otolaryngol Head Neck Surg 2012;146(4):574-578. Frequently occur in childhood. Occasionally, antrochoanal polyps may have a higher density (and Hounsfield values) if they are long-standing (i.e. Laryngoscope 2001; 111(10):1774-8. . As such, CT imaging is invaluable in confirming diagnosis of ACP. Common. Keywords: Choanal polyp; superior turbinate; endoscopic endonasal surgery Richard Towbin.
The antrochoanal polyp has a liquid component. Severe conductive hearing loss. . It passes through the ostium of the sinus into the choana, and from there into the posterior nasopharynx. 9.3 An axial computed tomography scan of a patient with a right antrochoanal polyp showing both maxillary and nasal components with a narrower part passing through an accessory ostium. A contrast-enhanced scan is not necessary but may demonstrate peripheral enhancement. . Endoscopic view of the left middle meatus. Antrochoanal polyp should be kept in differential diagnosis when a patient comes with unilateral nasal obstruction and discharge. In both cases, the diagnosis was done by nasal endoscopy and computed tomography (CT) of the paranasal sinuses and supported by Surgery is the only feasible treatment for antrochoanal polyp. Possible reasons for migration of antrochoanal polyp in to the post nasal space: 1. If present pale, edematous& pedunculated. turbinate hypertrophy. It is most commonly encountered in adults and rare in children. India At the end of history a differential diagnosis of nocturnal seizures, narcolepsy, parasomnias and obstructive sleep apnea was made. An antrochoanal polyp (ACP) is a benign sinonasal lesion that originates from the mucosa of the maxillary sinus. Br J Radiol. Other possible The accessory ostium through which the polyp gets out of the maxillary antrum is present posteriorly. 2000;10(5):849-51. These polyps have the same characteristic gross findings as ordinary antrochoanal polyps, with the addition of a reddish, vascular surface in some areas, an empty pterygopalatine fossa on CT, and .
ACPs can be diagnosed by taking a careful history and conducting clinical exam as well as nasal endoscopic and radiological examinations. Differential Diagnosis & Pitfalls. Antrochoanal polyps. Points of Evaluation Methods. 2. Antrochoanal Polyp. Differential Diagnosis: Antrochoanal polyp, inverting papilloma, minor salivary gland neoplasm, chronic sinus disease. Arise from wall of maxillary antrum, extending through large primary or secondary maxillary ostium into nasal cavity. Their histology, possible pathogenesis, the various symptoms, steps in the diagnostic procedure and differential diagnoses are also described. Antrochoanal polyp is a benign lesion originating from the mucosa of the maxillary sinus, growing through the accessory ostium into the middle meatus and, thereafter, protruding posteri- . Polyps are the most common expansile lesions of the nasal cavity 8.Incidence increases in patients with conditions known to be associated with polyps such as infectious rhinosinusitis, cystic fibrosis, aspirin sensitivity, allergic fungal sinusitis, asthma and nickel exposure 10. diagnose. The antrochoanal polyp, a benign solitary polypoid lesion, usually arises in a maxillary sinus, opacifying and enlarging the sinus cavity without bone destruction.
Antrochoanal polyps commonly present with nasal obstructive symptoms.2 Rarely, . Diagnosis of bleeding nasal mass is varied from benign to malignant lesions. The length of follow-up of patients should be for at least 2 years postoperatively in order to detect 95% of recurrence of antrochoanal polyps, which is more common in younger patients than adults and significantly higher in children. Bilateral antrochoanal polyps in an adult: a case report. Towbin RDJ, Bove K. Antrochoanal polyps. Introduction: Angiomatous antrochoanal nasal polyp (AAP) is a rare and distinct variation of a sinonasal polyp that can be mistaken for a sinonasal malignancy, juvenile nasopharyngeal angiofibroma, or a simple antrochoanal polyp due to its ability to erode bone and cause epistaxis. Antrochoanal polyps are the most common type of choanal polyps, representing 4-6% of all nasal polyps in the general population, 3 and commonly occur in children and young adults. A choanal polyp is a benign solitary sinonasal mass that originates in a paranasal sinus and secondarily extends into the nasal cavity. 4 - 6% of nasal polyps. Eur Radiol 2000;10(5):849-851. . Eur Radiol 10:849-851. doi: 10.1007/s003300051017. diagnosis is discussed. Discussion: Antrochoanal polyps are inflammatory lesions that cause obstruction of the maxillary sinus ostium with postobstructive sinus opacification. 2011;197:1309-1321. Typically, there is extensive vascular proliferation and ectasia . Although pathologically antrochoanal polyps have a narrow pedicle or stalk, this is usually not evident on CT. The polyp opacifies and slightly enlarges the sinus cavity with no bone destruction. This article also discusses the clinical features, pathogenesis, and surgical treatment of this entity. Investigations: Differential diagnosis: Investigations: Differential diagnosis The state of the art Endoscopy CT:computed tomography [no Plain X-ray] Culture Biopsy Acoustic Rhinometry [anatomy] Rhinomanometry [physiology] Reda Kamel, M.D. . Download Download PDF. Differential diagnosis: - Angiofibroma: usually manifests itself with symptoms of nasal obstruction and repeated episodes of epistaxis. The soft tissue mass does not Itgrows byextension from theantrum through . 4. - anatomopathological examination: will confirm the diagnosis.
5 Several possible mechanisms, . - Inverted papilloma: irregular lesion at . Antrochoanal polyp: 1- Inflammatory polyps 2- diffuse sinonasal polyps. De Vuysere S, Hermans R, Marchal G. Sinochoanal polyp and its variant, the angiomatous polyp: MRI findings. 10.2214/AJR.11.7420. The septum is on the far left. Pagella F, Emanuelli E, Pusateri A, Borsetto D, Cazzador D, Marangoni R, et al. They occur more commonly in children and young adults, and they are almost. Although very rare, a CP arising from the superior turbinate must be considered in the differential diagnosis of a solitary nasal polyp. Clinical, histological and radiological differential diagnosis of AAP are antrochoanal polyp, hemangioma, juvenile nasopharyngeal angiofibroma, inverted papilloma and malignancy. The diagnosis of angiomatous antrochoanal polyp is based on gross diagnostic criteria, detected on endoscopic examination and aided by CT scanning. These polyps have a discrete male predominance and are diagnosed usually between the third and the fifth decades of life. Unilateral Nasal Polyps. differential diagnosis for cystic lesions of the aerodigestive tract and present and an algorithmic, anatomically -based diagnostic approach . The different varieties of choanal polyps are reviewed by the authors according to their implantation pedicle. It is estimated that between 0.2% and 1% of the population will develop nasal polyps at some time; the incidence of nasal polyps increases with age. This report is based on three cases of antrochoanal polyp, occurring in the pediatric group, and the objective is to demonstrate their different CT characteristics, principal differential diagnoses, and . These polyps were classified grade III according to Chung et al.'s classification [ 6 ]. The differential diagnosis for ACPs is wide and includes juvenile angiofibroma, herniating mucocele, meningoencephalocele, teratoma, sphenochoanal polyps, and nasopharyngeal malignancies, among others [ 2, 7 ]. They are well defined and do not typically cause significant sinus expansion. Prognosis: Safe. The patient first received a medical preparation with steroids and antibiotics before endoscopic surgery. CT-scan demonstrates the presence of bone destruction. Frosini P et al: Antrochoanal polyp: analysis of 200 cases. Antrochoanal polyp differential diagnoses include ipsilateral nasal tumours such as angiofibroma, nasal glioma, encephalocele, mucocele, retention cyst, inverted papilloma or haemangioma. A short summary of this paper. Hughes ML et al: Persistent hypophyseal (craniopharyngeal) canal. There are two primary types of nasal polyps: ethmoidal and antrochoanal. A diagnosis of left antrochoanal polyp with obstructive sleep apnea was made. Full PDF Package Download Full PDF Package. The septum is on the far left. Antrochoanal polyp. Conclusion: Although this entity is rarely seen in daily clinical practice, great care is needed to catch the diagnosis for early treatment to avoid unwanted complications. A suction is visible on top of the inferior portion of the uncinate process and inferior portion of the polyp. diagnosis isdiscussed. Ethmoidal polyps arise from the ethmoid sinuses and extend through the middle meatus into the nasal cavity. The most common type is the antrochoanal polyp, which originates in the mucosa of the maxillary sinus or antrum. Discussion: Antrochoanal polyps are inflammatory lesions that cause obstruction of the maxillary sinus ostium with postobstructive sinus opacification. Finally, the various modes of treatment are discussed, focussing in . Differential Diagnosis: Antrochoanal polyp, inverting papilloma, minor salivary gland neoplasm, chronic sinus disease. It accounts for about 5% of all nasal polyps. The diagnosis of bilateral antrochoanal polyp was maintained upon clinical, radiological, endoscopic and histological findings. In rare cases, presenting symptoms may be atypical. Choanal and antrochoanal polyps are often unilateral, and inverted papilloma should always be included in the differential diagnosis. SAP is believed to be a derivative of the antrochoanal polyp. 72(854 . sphenochoanal polyps. 14 An antrochoanal polyp arises from the maxillary sinus and protrudes through the sinus ostium into the nasal cavity. AMA Arch Otolaryngol 52:538-48. 90% solitary. Benign lesions such as mucous retention cyst, antrochoanal polyp, mucocele, Tornwaldt cyst (located in the midline of the nasopharynx), . They are well defined and do not typically cause significant sinus expansion. 
The primary differential diagnosis includes inflammatory / allergic polyp, which typically shows more eosinophils and more submucous glands (Acta Otolaryngol 1995;115:543). Antrochoanal polyps (ACP) are benign, large, inflammatory polyps which originate from within the maxillary sinus and extend through the natural or accessory ostia, into the nasal . Diagnosis: Right antrochoanal polyp (ACP) . Antrochoanal polyps in children: CT findings and differential diagnosis. A retention cyst derived from a salivary . There is a high incidence of benign non-neoplastic lesions in our study, constituting about 77.6% of cases while 2.6% were malignant and 19.7% had no pathologic diagnosis. Am J Antrochoanal polyps usually arise in the maxillary sinus and extend into the nasopharynx and represent only 4-6% of all nasal polyps. Antrochoanal polyp (Killian polyp) is an infrequent, usually solitary, benign, slowly growing lesion that arises from the maxillary antrum and reaches the choana. mors, which would serve as differential diagnosis. Differential diagnosis. Ossicles: Usually intact Usually necresed Hearing loss: Mild conductive hearing loss. . Solitary polyps of the uncinate process To the best of our knowledge, no case of a sphenochoanal polyp with concomitant obstructive sleep apnea has been reported, and only 2 cases (13,14) of an antrochoanal polyp . Differential Diagnosis. DIFFERENTIAL DIAGNOSIS 1. Differential diagnosis also includes congenital defects (such as neural tube defects, dermoid cyst, meningocele, and meningoencephalocele), lymphatic tissue hypertrophy, benign tumors (nasal glioma, neurofibroma, craniopharyngioma, and juvenile nasopharyngeal angiofibroma), and malignancies (rhabdomyosarcoma, lymphoma, and nasopharyngeal carcinoma). Radiographic examination with CT-scan and more rarely MRI helps the diagnosis. Why? The differential diagnosis of a choanal polyp includes inverted papilloma; these may look identical on unenhanced sinus CT, with characteristic calcification reported in 10% of inverted papillomas (Figure 10). Differential Diagnosis. The polyp may then extend posteriorly toward the choana and sometimes into the nasopharynx. . 29(1):21 -6, 2009. . Nasal presenting symptoms are unilateral obstruction and nasal discharge. It can be differentiated from antrochoanal polyp by endoscopic examination, CT scan and/or MRI. Differential diagnoses of maxillary masses found in imaging include5 6 7. mucus retention cysts (most frequent) adenoid hypertrophy. Benign lesions of the maxillary sinus can be conveniently divided into nonneoplastic and neoplastic . 3. May pass into choanae or nasopharynx. desiccated) and/or have an associated fungal infection (see fungal sinusitis) 1. Objective. Misinterpretation of the REAH as chronic sinus inflammation may result in inadequate treatment. Epidemiology. American Journal of Roentgenology. Pruna X, Ibaez JM, Serres X, et al (2000) Antrochoanal polyps in children: CT findings and differential diagnosis. Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. In order to avoid any recurrence of disease, it is important to choose the best surgical approach for removal of ACP with respect to the site of attachment within the maxillary sinus walls. Clinical features and management of antrochoanal polyps in children: Cues from a clinical series of 58 patients. 37 Full PDFs related to this paper. The differential diagnosis includes antrochoanal polyp, hypertrophied adenoids, Thornwaldt cyst pituitary tumours, lymphoma, and carcinoma.5 Treatment During the procedure, by tracing the polyp proximally, we were able to confirm its exit through the ostium of the sphenoid sinus on the left side. T1-Weighted Imaging-Based Differential Diagnosis. Clinical features and management of antrochoanal polyps in children: Cues from a clinical series of 58 patients. The differential diagnosis of nasal polyps can be extensive. If present reddish, fleshy & sessile. The differential diagnosis of ACP should include other pediatric masses. INVESTIGATIONS Nasal endoscopy May reveal choanal or antrochoanal polyp hidden posteriorly in the nasal cavity Xrays of paranasal sinuses May show opacity of the involved antrum Lateral view xray: globular swelling in postnasal space column of air behind the polyp 22. The inspiratory air current is more powerful than the expiratory air current thereby pushes the polyp posteriorly. The antrochoanal polyp, a benign solitary polypoid lesion, usually arises in a maxillary sinus, opacifying and enlarging the sinus cavity without bone destruction. It passes through the ostium of the sinus into the choana, and from there into the posterior nasopharynx. The antrochoanal polyp, usually asolitary benign growth, arisesfromthemaxillary antrum ofanonatopic patient. 2. The differential diagnosis of ACPs should include juvenile angiofibroma, nasal glioma, meningoencephalocele, inverted papilloma, mucocele, mucus retention cyst, Tornwalt's cyst, grossly enlarged adenoids, lymphoma and nasopharyngeal malignancies ( 1 - 3, 8, 28, 31 ). 9. While there are benign unilateral polyp etiologies such as an antrochoanal polyp, the suspicion for malignancy should be high and a referral to an otolaryngologist is indicated for a biopsy. The lateral nasal wall is on the far right. This Paper. 3. The . Acta Otorhinolaryngol Ital. Local recurrence is common following surgical removal, . Ylmaz YF, Titiz A, zcan M, Tezer MS, zlgedik S, nal A. ethmoidochoanal polyps. Differential Diagnosis Thediagnosis ofantrochoanal polyp isstrongly sug-gested whenanopacified maxillary antrum isexpanded andthere isanasopharyngeal mass. Because the infection is Other causes of nasal mass lesions, for example, antrochoanal polyp, nasal polyp, encephalocele, and other rare neoplasms: inverted papilloma, squamous cell carcinoma, adenocarcinoma, esthe-sioblastoma, rhabdomyosarcoma; Other causes of orbital swelling or proptosis; Find methods information, sources, references or conduct a literature review on . 3. Itgrows byextension from theantrum through . Sphenochoanal polyps arise from the sphenoid sinus and pass through choanae to nasopharynx. Pagella F, Emanuelli E, Pusateri A, Borsetto D, Cazzador D, Marangoni R, et al. The antrochoanal polyp. Magnetic resonance imaging has led to substantial advances in the preoperative differential diagnosis of cholesterol granuloma. The antrochoanal polyp or Killian polyp is an infrequent, benign lesion of maxillary origin (90%); it can also develop from the sphenoidal sinus, the ethmoid sinus, the septum, the palate or the frontal sinus. diagnosis is made on the basis of clinical, CT and pathological data. angiofibroma. It warrants special consideration in children because its clinical manifestations may be mimicked by other less benign conditions, such as juvenile angiofibroma, meningoencephalocele, and nasopharyngeal malignancies.
1 On CT images, . Because it's much less liable to cause complications. Pruna X, Ibanez J, Serres X, Garriga V, Barber I, Vera J. Antrochoanal polyps in children: CT findings and differential diagnosis. Antrochonal polyp is a unilateral and benign tumor of the maxillary sinus occurring in children. Hong SK, Min YG, Kim CN, Byun SW. Endoscopic removal of the antral portion of antrochoanal polyp by powered instrumentation. In the present investigation, 11 patients (68.75%) A retrospective cohort study was carried out by analysing a database of 82patients who were . It grows by extension from the antrum through its ostium. Differential Diagnosis. B-ENT 2007;3:97-9. Most simple inflammatory nasal polyps are classed as chronic rhinosinusitis with nasal polyps, which are bilateral. 1 Sphenochoanal polyps are of uncertain etiology. Nasal polyps, antrochoanal polyps, inverted papilloma, unilateral chronic odontogenic sinusitis with secondary polyps due to chronic infection, unilateral fungal sinusitis, mucoceles, malignancy and cystic fibrosis (similar appearance but commonly bilateral). Explore the latest full-text research PDFs, articles, conference papers, preprints and more on DIAGNOSTIC METHODS. 4 Polyp extension . Angiomatous antrochoanal polyps (AAP) are one of the causes but it is rare and the diagnosis is challenging as it mimic other nasal mass especially nasopharyngeal angiofibroma (NA). The lateral nasal wall is on the far right. ACPs should be considered in the differential diagnosis of unilateral nasal obstruction and a nasal mass. Simple nasal polyps and antrochoanal polyps were the most common non-neoplastic sinonasal masses in this study forming up to 57(75%). A retrospective investigation was performed on . The polyp is directly in the center and is pale, glistening, and white. Vera J. Antrochoanal polyps in children: CT findings and differential diagnosis. The first description of choanal polyps was reported by Killian in 1906; Killian defined them as an isolated, solitary paranasal sinus mass or cyst, which protrudes into the boundaries between the nasal cavity and the nasopharynx, or even down to the oropharynx .According to Lopatin et al., these polyps can arise from the maxillary sinus (antrochoanal polyps), sphenoid sinus (sphenochoanal . Though it is commonly seen in young adults, rarely, children . Antrochoanal polyps represent only 4-6% of all nasal polyps in the general population but account for approximately one third of polyps in the pediatric population. Differential diagnosis of primary nasopharyngeal lymphoma and nasopharyngeal carcinoma focusing on CT, MRI, and PET/CT. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence. Fig. Christopher J. Hanrahan, Lubdha M. Shah. . Reference Lee, Yoon, Lee and Lim 11, Reference Lee and Huang 12. To investigate the length of follow-up needed to detect recurrence of antrochoanal polyps. 2 Due to its relatively deep seated location, it results in a late presentation. Antrochoanal polyp is known to occur in inflamed, edematous mucosa of the maxillary sinus or an accessory ostium. Other possible In this age group, adenoid hypertrophy is a very common finding and the symptoms may resemble those of ACP, like nasal obstruction, chronic rhinorrhea and snoring. Killian's Polyps happen more commonly in children and young adults. Central or . These polyps are usually presented unilaterally, although bilateral presentation is also possible. A suction is visible on top of the inferior portion of the uncinate process and inferior portion of the polyp. sinonasal tumours (eg, olfactory neuroblastoma, inverted papilloma, haemangioma, malignancies). Differential Diagnosis Thediagnosis ofantrochoanal polyp isstrongly sug-gested whenanopacified maxillary antrum isexpanded andthere isanasopharyngeal mass. Choanal polyps are unilateral.
Salib RJ, Sadek SA, Dutt SN, Pearman K. Antrochoanal polyp presenting with obstructive sleep apnoea and cachexia. The antrochoanal polyp, or Killian's Polyp is a be-nign, solitary lesion that affect mainly children and young . Differential diagnosis The diagnosis of ACP may be challenging, mainly in young children (5-8 years). Thus, REAH can be mistaken for inverted papilloma, nasal polyp, antrochoanal polyp, and even with low-grade adenocarcinoma. The antrochoanal polyp, usually asolitary benign growth, arisesfromthemaxillary antrum ofanonatopic patient.
American Journal of Roentgenology, 1979. 8. Stammberger H (1986) Nasal and Paranasal Sinus Endoscopy A Diagnostic and Surgical Approach to The differential diagnosis is between ACP and tumours such as angiofi broma, olfactory neuroblastoma, meningo-encefalocele or hemangioma. diagnosis isdiscussed.
European radiology. Endoscopic view of the left middle meatus.
Consequently, the differential diagnosis is crucial in this entity. Why? Therefore, histologic confirmation of nasal growths is mandatory in most instances. The prominent dilated vessels of the antrochoanal polyp can also be a helpful distinguishing feature. Int J Pediatr The most common type is the antrochoanal polyp, which originates in the mucosa of the maxillary sinus or antrum. Polyp: Uncommon. Antro-choanal polyp is generally recognized to represent approximately 4-6% of all nasal polyps; however, it is much more prevalent in the pediatric population. The antrochoanal polyp, a benign solitary polypoid lesion, usually arises in a maxillary sinus, opacifying and enlarging the sinus cavity without bone destruction. The two general differential diagnoses are inverted papilloma .
The initial impression was of a swollen uvula from angioedema secondary to ACE inhibitor use.1 Repeat examination revealed a large antrochoanal polyp to be the cause of his symptoms. The differential diagnosis mainly includes other inflammatory nasal . Inverted . Polysomnography was not available and could not be done to document obstructive sleep apnea. A suspicion of hemangioma (cavernous/capillary) may arise due to occurrences of recurrent bleeding, but this diagnosis was not supported by radiological findings . Eur Radiol 2000;10:849-51. Papilloma - they are irregular and friable in appearance and bleed easily; Meningoencephalocele (see meningocele, encephalocele) . The polyp is directly in the center and is pale, glistening, and white.