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Yan H, Bao X, Jiang T, Li T, Fu W, Guo M, Geng Z, Zhang M, Yu L. The anatomical variations of paranasal sinuses may be related to the formation of antrochoanal polyp by computed tomography imaging study. Quant Imaging Med Surg 2024; 14:592-603. [PMID: 38223026 PMCID: PMC10784031 DOI: 10.21037/qims-23-1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
Background There is little investigation into the connection between anatomic variations and the development of antrochoanal polyp (ACP), and the etiology of ACP remains unclear. The study aims to explore the relationship among anatomic variations, maxillary sinus volume, nasal meatus-related parameters, and the occurrence of ACP. Methods There were 127 patients included in this retrospective cross-sectional study with unilateral ACPs hospitalized at Shandong Provincial ENT Hospital between February 2010 and February 2020. Evaluation indicators included anatomic variations, maxillary sinus volume, and nasal meatus-related parameters in 45 children and 82 adults, which were evaluated twice by 3DSlicer software. Parameters were assessed using the Kolmogorov-Smirnov test, followed by paired t-test and Chi-squared test for multiple comparisons. Results Significant differences were found in the accessory maxillary ostium (AMO) and maxillary sinus retention cyst between two sides (both P<0.001). Maxillary sinus volume and sex had an association of statistical significance on adults' ACP side (P=0.026) and non-antrochoanal polyp (non-ACP) side (P=0.032). The affected side's maxillary sinus volume was significantly larger than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was larger than the non-ACP side in children (P=0.044). Males' length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate of the ACP side was considerably greater than the healthy side (P<0.001). The length from the maxillary sinus orifice to the plane of the most lateral margin of the middle turbinate (P=0.014) and the length from the inferior turbinate to the nasal septum (P=0.013) on the non-ACP side was higher than the affected side in adults. Males' length from the inferior turbinate to the nasal septum was higher on the healthy side than the affected side (P<0.001). Males had a greater maximum length from the maxillary sinus lateral wall to the nasal septum (P=0.024) and the length from the inferior turbinate to the nasal septum (P=0.003) on the non-ACP side than females. Males had a larger maximum length from the maxillary sinus lateral wall to the nasal septum on the ACP side than females (P=0.011). Conclusions In our study, the occurrence of the AMO, the maxillary sinus's expanded size, and the stenosis of the associated channels around the ostiomeatal complex and common meatus are regarded as probably connected to the formation of ACPs. In addition, the anatomic variations that involve the ostiomeatal complex and may lead to a change in maxillary sinus pressure and nasal ventilation are important factors in the formation of ACPs.
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Affiliation(s)
- Haoyi Yan
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Xiangyuan Bao
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Tianjiao Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Tong Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wenting Fu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Mengqi Guo
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Zijun Geng
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Mei Zhang
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
| | - Liang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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Alharbi SM, Alshehri AM, Erwe IH. Huge Antrochoanal Polyp: A Case Report. Cureus 2023; 15:e45592. [PMID: 37868396 PMCID: PMC10587913 DOI: 10.7759/cureus.45592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Antrochoanal polyps are benign lesions arising from the maxillary sinus mucosa. The most common patient complaint is unilateral nasal obstruction. Nasal endoscopy and computed tomography are the gold standard modalities for diagnosis. Treatment is surgical. We report the case of a 19-year-old female suffering from a huge antrochoanal polyp who went to hospital following a choking episode. While being prepared for surgery, she vomited, and the polyp was expelled from her mouth. Right maxillary sinus antrostomy was done to remove the polyp base to avoid recurrence.
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Affiliation(s)
- Salmah M Alharbi
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
| | - Anas M Alshehri
- Otorhinolaryngology-Head and Neck Surgery Department, Khamis Mushayt General Hospital, Khamis Mushayt, SAU
| | - Ibrahem H Erwe
- Otorhinolaryngology-Head and Neck Surgery Department, Aseer Central Hospital, Abha, SAU
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Rozendorn N, Warman M, Zloczower E, Mansour J, Yakirevitch A. Significance of nasal septal deviation among patients with antrochoanal polyp. J Laryngol Otol 2023; 137:921-924. [PMID: 36515175 DOI: 10.1017/s0022215122002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to examine the association between nasal septal deviation and antrochoanal polyp. METHODS This was a retrospective review of medical records and imaging of patients who underwent endoscopic sino-nasal surgery for antrochoanal polyp. RESULTS Forty-eight patients operated on for antrochoanal polyp between 2009 and 2019 were eligible for the study. The median age was 32 years, and 52.1 per cent were male. Antrochoanal polyp was diagnosed equally in the right and left nasal cavities. Septal deviation was present in 77 per cent of such cases. In 44 per cent of septal deviation cases, the antrochoanal polyp was ipsilateral to the deviation, which was not statistically significant. The type of deviation according to the Mladina classification was not correlated with the laterality of septal deviation and antrochoanal polyp. CONCLUSION The laterality of the septal deviation was not found to be correlated with that of the antrochoanal polyp. Therefore, performing routine septoplasty during antrochoanal polyp surgery is unnecessary unless the deviation interferes with the complete extraction of the polyp.
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Affiliation(s)
- N Rozendorn
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - M Warman
- Department of Otolaryngology - Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - E Zloczower
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - J Mansour
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - A Yakirevitch
- Department of Otolaryngology - Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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Garaycochea O, Van Strahlen CR, Alobid I, Mullol J. Pheno-Endotyping Antrochoanal Nasal Polyposis. Curr Allergy Asthma Rep 2023; 23:165-180. [PMID: 36773125 DOI: 10.1007/s11882-023-01066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE OF REVIEW Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the inner wall of the maxillary sinus and extending into the choana. Although the diagnosis and treatment strategies of ACP have changed since this entity was first described, the underlying pathogenic mechanism of APC is poorly understood. This article reviews the current knowledge of the etiology, inflammatory parameters, and microscopic findings of ACP. RECENT FINDINGS The inflammatory pattern of ACP appears to center around a neutrophilic inflammation T1-dominant endotype. Apart from the inflammatory component of ACP, at the microscopic level, the presence of tissue remodeling, mostly fibrin deposition and edema, and cysts in the epithelium and lamina propria has been described. Although the origin of this T1-dominant endotype immune response of ACPs is not entirely clear, it could be related to a lymphatic obstruction mechanism. This review serves to define a phenotype of ACP with potential endotypes based on the characteristics of the inflammatory parameters, microscopic findings, and hypotheses about the pathogenesis of ACP.
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Affiliation(s)
- Octavio Garaycochea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Camilo Rodríguez Van Strahlen
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain.,Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, CIPERES, Barcelona University, Barcelona, Spain
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Short SH, Pollack E, Williams RL, Chennupati S. Nasopharyngeal Mass in an 11-year-old Female Pediatric Patient. Pediatr Rev 2021; 42:160-163. [PMID: 34470899 DOI: 10.1542/pir.2019-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Spencer H Short
- University of South Florida Morsani College of Medicine, Tampa, FL.,Lehigh Valley Health Network, Allentown, PA
| | - Emily Pollack
- Lehigh Valley Health Network, Allentown, PA.,Lehigh Valley Reilly Children's Hospital, Allentown, PA
| | | | - Sri Chennupati
- University of South Florida Morsani College of Medicine, Tampa, FL.,Lehigh Valley Health Network, Allentown, PA.,Lehigh Valley Reilly Children's Hospital, Allentown, PA
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Başer E, Sarıoğlu O, Arslan İB, Çukurova İ. The effect of anatomic variations and maxillary sinus volume in antrochoanal polyp formation. Eur Arch Otorhinolaryngol 2019; 277:1067-1072. [PMID: 31848733 DOI: 10.1007/s00405-019-05762-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The antrochoanal polyp (ACP), otherwise known as the Killain polyp, is a benign lesion that originates from maxillary sinus mucosa, extending from the accessory ostium towards the middle meatus, and later tends to protrude posteriorly towards the choana and nasopharynx. Many studies have emphasized that its etiopathogenesis is unclear. Research suggests that chronic sinusitis and allergic rhinitis are factors that play an important role in the formation of ACP, as well as anatomical variations. In this study, we aimed to evaluate the effect of anatomical variations and maxillary sinus volume in patients diagnosed with anthrochoanal polyp. METHODS Paranasal sinus computed tomography (PNS CT) images of patients with unilateral ACP patients were examined. The non-ACP sides of the patients comprised the control group. Nasal septal deviation, agger nasi cells, concha bullosa, paradoxical middle turbinate, hyperpneumotized ethmoid bulla, uncinate pathology (medialized or pneumatized uncinate), haller cell, accessory ostium, maxillary sinus retention cyst and maxillary sinus volumes were evaluated. RESULTS The study included a total of 54 patients (33 females, 21 males). Mean patient age was 22.92 ± 13.95 (range 6-56) years. Mean maxillary sinus volume was 17.88 ± 5.16 mm3 for the ACP sides and 16.37 ± 4.55 mm3 for the non-ACP sides. Maxillary sinus volume was significantly larger in the ACP side (p = 0.000). Concha bullosa was observed on the ACP side in 23 patients (42.6%) and in the non-ACP side in 21 patients (38.9%). Agger nasi cells were observed in the ACP side in 47 patients (87.0%) and in the non-ACP side in 42 patients (77.7%). Hyperpneumatized ethmoid bulla was observed in the ACP side in 14 patients (25.9%) and in the non-ACP side in 12 patients (22.2%). Haller cells were observed in the ACP side in seven patients (12.96%) and in the non-ACP side in ten patients (18.51%). CONCLUSION Disrupted airflow of the well-developed maxillary sinus cavity due to anatomical variations seems to be an effective factor in the formation of ACP.
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Affiliation(s)
- Engin Başer
- Otorhinolaryngology Clinic, Univercity of Health Science, Tepecik Training and Research Hospital, İzmir, Turkey.
| | - Orkun Sarıoğlu
- Radiology department, Univercity of Health Science,Tepecik Training and Research Hospital, İzmir, Turkey
| | - İlker Burak Arslan
- Otorhinolaryngology Clinic, Univercity of Health Science, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İbrahim Çukurova
- Otorhinolaryngology Clinic, Univercity of Health Science, Tepecik Training and Research Hospital, İzmir, Turkey
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Aksakal C. Konka Büllöza tipleri ile septum deviasyonu ve maksiller sinüzit arasındaki ilişkinin araştırılması: 293 paranazal bilgisayarlı tomografinin analizi. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.469534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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