Removal by combined approach-Caldwel Luc and FESS
large antrochoanal polyp extending upto oropharynx
Antrochoanal polyps (ACP) are non allergic benign polyp, which arises from the maxillary sinus, go through its ostium and extends all the way to the ipsilateral choana.
The patient usually presents with unilateral nasal obstruction. Other symptoms like mucopurulent rhinorrhea, epistaxsis, sleep disorders, postnasal drip, headaches, hyposomia, mouth breathing and snoring. It commonly affects children and young adults.
On examination there may be a unilateral polypoidal nasal and/or rhino-pharyngeal mass visible.
CT scan shows a solid well-delineated mass appears emerging from the maxillary sinus, and approaching the choanal or even to the oropharynx.
The basic treatment for the antrochoanal polyp is unanimously same, surgical removal of the nasal part along with the complete removal of the antral part, in order to reduce the recurrence.
Since 1906, when Killian described the maxillary sinus as the site of origin for the polyp, many surgical techniques have been proposed. These include the Caldwell-Luc procedure, Endoscopic polypectomy with middle meatal antrostomy, Endoscopic polypectomy with antrostomy through the inferior meatus and Endoscopic polypectomy with middle meatal antrostomy (FESS) and the use of microdebrider with or without transcanine access.
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