Killian’s Antro Choanal Polyp

Killian Polyp:Antrochoanal Polyp
Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India www.drpaulose.com www.snorefreesleep.com

Killian’s Antrochoanal Polyp

It was Killian in 1906 who described the origin of antral polyp and he named it as Antro Choanal Polyp.

Antrochoanal polyp is a benign solitary polypoidal lesion arising from the maxillary sinus antrum causing opacification and enlargement of antrum radiologically without any evidence of bone destruction. It exits the antrum through the accessory ostium reaches the nasal cavity, expands posteriorly to exit through the choana into the post nasal space.

It commonly affects children and young adults. The antrochoanal polyp is dumb bell shaped with three components i.e. antral, nasal and nasopharyngeal. Its etiology is still unknown.

Polypoidal tissue from the maxillary antrum exits out through the accessory maxillary sinus ostium according to some workers. This accessory sinus ostium is placed posteriorly, which could be the reason for the polyp to present posteriorly. The accessory sinus ostium widens progressively, ultimately at one stage merging with the natural ostium of the maxillary sinus forming one huge opening into the maxillary antrum.

CT scan coronal section showing antral polyp extending out of the antrum via the accessory ostium

Surgical Treatment:

This is a surgical problem. Formerly it was treated by avulsion of the polyp transnasally. This method led to recurrences.

A Caldwell luc approach was preferred in patients with recurrences. In Caldwell luc procedure in addition to the polypectomy, the maxillary antrum is entered via the canine fossa and the antral component is completely excised.

FESS-Endoscopic approach: With the advent of nasal endoscope this approach is the preferred one. Using an endoscope it is always easy to completely remove the polypoid tissue. The uncinate process must also be completely excised. Endoscopic approach has the advantage of a complete surgical excision with negligible recurrence rates.

A Combined –FESS and Caldwell Luc approach gives complete cure.