Choanal polyps: Variant sites of origin

Document Type : Original Article

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Otorhinolaryngology department, Faculty of Medicine, Sohag University

Abstract

Introduction: Choanal polyps (CPs) are benign inflammatory lesions that arise from the mucosa of the nasal cavity and paranasal sinuses and migrate through the choana to the nasopharynx.
Objectives: All patients with choanal polyps (CPs) operated upon over 10 years were retrospectively recorded to draw attention to such cases and their management.
Patients and Methods: This study was conducted on 117 patients presented with choanal polyps based on a detailed history, physical examination, and necessary investigation (CT nose and paranasal sinuses axial and coronal cuts).
Results: We faced 117 patients with CPs. Antrochoanal polyp (ACP) was the commonest variety, occurring in 94/117 (80.3%) of cases, 5 of them were simultaneously occurring bilateral ACPs. Choanal polyps with unusual sites of origin occurred in 23/117 (19.7%) of cases; 9/23 were ethmochoanal polyps (ECPs) with a free maxillary sinus in CT; 9/23 were sphenochoanal polyps (SCPs); 5/23 were turbinochoanal polyps (TCPs) arising from the inferior and middle turbinates. Endoscopic sinus surgery was done in all cases, with alleviation of symptoms. Recurrence occurred in 2 cases with ACPs.
Conclusion: ACP is the usual and most common variety of CPs; yet, CPs with unusual sites of origin occurred in 19.7% of cases. Nasal endoscopy, CT scanning, and endoscopic examination under anesthesia are essential to identify the site of CP origin. Thus, complete removal of the polyp with its fixation site(s) could be done and unnecessary surgery on unaffected sinuses could be avoided. Histopathological confirmation of the diagnosis should be considered in suspicious cases.
 

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