Difference of Antrochoanal Polyps Between Children and Adults in the Chinese Population

OBJECTIVE

This study aims to find the difference in clinical and immunopathological characteristics between children and adults with antrochoanal polyps (ACPs) in the Chinese population.

METHODS

The clinical data of 69 patients diagnosed with ACPs were retrospectively analyzed. Cytokine levels in 16 controls and 40 ACPs tissues were determined by quantitative real-time polymerase chain reaction (qPCR). The expression of matrix metalloproteinase (MMP)-9 was measured using qPCR, immunofluorescent staining, and western blot.

RESULTS

There were 51 (73.9%) children (<18 years old) and 18 (26.1%) adults (≥18 years old). The sex ratio differed significantly between the two groups (p = 0.0032). There were no significant differences in the nasal side of ACPs and approaches to surgery between the two groups. In both groups, the most common symptom was nasal obstruction, followed by nasal discharge. As for associated nasal diseases, there was a significant difference between the two groups in septal deviation (p = 0.0223). Adult patients showed significantly higher expression of IL-8 mRNA than children (p = 0.0424). The mRNA and protein levels of MMP-9 were also significantly higher in adult patients than in children (p = 0.0498 and 0.0009, respectively).

CONCLUSION

In the Chinese population, the comorbidities and immunopathological characteristics of adult ACP patients are different from those of children. The level of IL-8 and MMP-9 was significantly higher in ACPs of adults than in children, which may contribute to the more severe tissue remolding in adult ACP patients.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2093-2099, 2024.

Huge Antrochoanal Polyp: A Case Report

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.

Bilateral antrochoanal polyp: a case report of an extremely rare entity managed conservatively with a review from the past 26 years

Antrochoanal polyp (ACP) is a well-known benign sinonasal polyp first described in the early 20th century. ACP mostly presents as a unilateral mass and is treated solely with surgical excision.

Temporary Submucosal Inferior Maxillary Antrostomy: A Modification of the Inferior Antrostomy

Complete removal of maxillary sinus pathology can be challenging in specific locations. In the past, the Caldwell-Luc procedure was used for maxillary sinus disease. Currently, the endoscopic middle meatal antrostomy (EMMA) approach is used. However, it can often be difficult to reach certain locations of lesions by EMMA alone, requiring an endoscopic inferior meatal antrostomy (EIMA), which has been reported in the literature to have numerous complications. Furthermore, multiple techniques have been suggested for a combined bi-meatal approach to remove such lesions. We present a case of a 17-year-old with a challenging antrochoanal polyp (ACP) location requiring EIMA. The patient underwent our modified technique of submucosal inferior antrostomy with mucosal flap with no observed intra-operative and post-operative complications. Maxillary sinus pathology can be challenging due to limited access to specific regions. In this case report, we present a novel technique to achieve a temporary inferior antrostomy through a minimally invasive approach with a promising post-operative course.

Antrochoanal Polyp in Anterior Nasal Cavity: A Case Report

We report a case of antrochoanal polyp, which has unusual presentation according to the location of the polyp in a 15-year-female patient. The patient came complaining of nasal obstruction, headache, and postnasal drip for a two-week period. The antrochoanal polyp measured 2.5 x 2 cm in the left maxillary sinus and extended to the anterior part of the nasal cavity. CT imaging demonstrated a total opacified left maxillary sinus, maxillary ostium with widening of the left maxillary ostium by polypoid mucosal thickening suggesting an antrochoanal polyp obstructing the left anterior nasal cavity. This case is reported as there are not many articles in world literature describing an antrochoanal polyp presented in the anterior nasal cavity.

A comparison of two endoscopic techniques for the treatment of antrochoanal polyps

An antrochoanal polyp (ACP) is a benign sinonasal lesion that originates from the mucosa of the maxillary sinus. 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. A retrospective cohort study was carried out by analysing a database of 82 patients who were operated on for ACPs in the Ear, Nose and Throat (ENT) clinics of both Sant’Orsola-Malpighi Polyclinic Hospital and Bellaria Hospital in Bologna, Italy from January 2001 to November 2017 to compare the rate of recurrence of ACPs after surgical removal using two different approaches. The first technique was endoscopic antrochoanal polypectomy with middle meatal antrostomy and the second was endoscopic antrochoanal polypectomy combined with both middle meatal antrostomy and a minimal access through the inferior meatus. A total of 49 patients were operated on with an endoscopic polypectomy with middle meatal antrostomy and 18.4% experienced a recurrence. The remaining 33 patients underwent endoscopic polypectomy with combined middle meatal antrostomy and access through the inferior meatus with a recurrence rate of 3%. The difference between the two groups was statistically significant (p = 0.0441). The strategy of the authors, namely combining medial antrostomy with a small inferior meatus access, was associated with a lower rate of recurrence and no increased morbidity in the short- or long-term.

Topical mitomycin C application post endoscopic removal of antrochoanal polyp

OBJECTIVE

Assessment the effect of topical application of mitomycin-C (MMC) after endoscopic removal of antrochoanal polyp (ACP) on its recurrence rate.

METHODS

This prospective study was done on patients with ACP. Endoscopic nasal surgery has been done to remove the polyp after wide middle meatal antrostomy. The patients were categorized into two groups. In MMC group, after endoscopic ACP removal, MMC on a piece of cotton was topically applied inside the maxillary antrum in the suspected site of ACP origin. A second group was used as a control group without MMC application.

RESULTS

The study included on 40 patients; 20 patients in each group. Topical MMA application was easily performed. No granulation, crust, infection, or bleeding was reported in all cases of both groups. Recurrent polyp was not reported in MMC group, while recurrent polyp was detected in four cases (20%) in control group without MMA application with statistically significant difference (P = .035).

CONCLUSION

Topical MMC application inside the maxillary sinus after endoscopic removal of the ACP is safe, easy, and effective.

LEVEL OF EVIDENCE

2c.

Do Blood Cell Parameters have a Predictive Role in the Etiology and Severity Pediatric Antrochoanal Polyp Cases?

Introduction  There are no definitive parameters to guide the etiology and severity of pediatric antrochoanal polyps.

Objective  The aim of our study is to compare the values of blood cell distribution parameters in cases of pediatric antrochoanal polyps (ACPs) with those of the control group. These values may be guiding parameters in determining the etiology of ACPs and evaluating the severity of the disease and the risk of recurrence.

Methods  Blood count values of patients operated for pediatric ACPs were retrospectively analyzed and compared with the data of the control group with the same age and gender distribution. The ACPs group was divided into subgroups in terms of inflammation, severity, and recurrence, and these subgroups were statistically compared as well.

Results  When the ACP patient group and the control group were compared, there was no statistically significant difference between the two groups. When we compared the patients considering the CT findings, there was a statistically significant difference between the stage III patients and the control group in terms of mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR) values ( p  < 0.05 in both). Similarly, the MPV and PLR values were significantly higher in the recurrence patient group than in the control group. ( p  < 0.05 in both).

Conclusion  As a result of the data obtained, it can be suggested that inflammatory parameters in pediatric cases of ACPs vary in terms of recurrence and the severity of the disease.

Investigation of Oxidative Stress in Antrochoanal Polyp Etiology

Antrochoanal polyps (ACPs) are benign lesions of the paranasal sinuses. Similarities between ACPs and nasal polyps have been previously investigated. However, oxidative stress has been implicated but not investigated in terms of the etiology of ACPs. Thus, the aim of this study was to investigate oxidative stress in the etiology of ACPs. The study population comprised 93 patients divided into 3 groups. Group 1 consisted of 30 patients with ACPs. Group 2 consisted of 33 patients with nasal septal deviation. Group 3 comprised 30 healthy individuals. Venous blood was taken from all participants, and total thiol, native thiol, disulfide, and ischemic modified albumin (IMA) levels were evaluated. When the values of native thiol (P = .097), disulfide (P = .221), total thiol (P = .140), and IMA (P = .091) were compared, no significant differences were found among the 3 groups. While many studies have been conducted related to nasal pathologies and the role of oxidative stress in their etiologies, our study concluded that oxidative stress plays no role in ACP etiology.

The clinicopathological features of sinonasal angiomatous polyps

BACKGROUND

Sinonasal angiomatous polyp (SAP) is a rare subtype of sinonasal polyp that might be misdiagnosed as a malignant lesion due to its clinical symptoms.

METHODS

We retrospectively enrolled the patients who were diagnosed with SAP in our hospital during 2008-2015. We analyzed the clinical symptoms, radiological findings, and pathological features of all patients diagnosed with SAP.

RESULTS

Unilateral nasal obstruction, rhinorrhea, and epistaxis were the common symptoms. SAPs all originated from maxillary sinus and extended to nasal cavity with or without involving the nasopharynx. Expansile mass with surrounding bony destruction is typical on computed tomography imaging but specific for SAPs. The magnetic resonance revealed high signal intensity on T1-weighted images and hypointense rim on T2-weighted images.

CONCLUSION

Computed tomography and magnetic resonance together might give rise to more accurate diagnosis of SAP. Incisional biopsy does help if the clinician suspects a malignant lesion. To treat SAP, complete removal is the optimal choice.

Characteristics of antrochoanal polyps in the pediatric age group

OBJECTIVES:

To evaluate and compare the clinical and the pathological characteristics of antrochoanal polyps (ACPS) in adults and children.

MATERIALS AND METHODS:

Medical records of 35 patients (19 children, 16 adults) operated upon for ACPS between 1995 and 2005 at an academic tertiary center were reviewed retrospectively. Demographic characteristics, clinical presentation, surgical management, histological findings and recurrence rate were compared.

RESULTS:

Of the 35 patients, 19 (54%) were children (mean age, 12.6 years) and 16 (46%) were adults (mean age, 31.4 years). Nasal obstruction was the most common presenting symptom in both groups. The incidence of snoring and/or obstructive sleep apnea was statistically significant, more common among the pediatric age group as compared to the adult group (P =.001). Epistaxis was also found to be more common among the pediatric age group (P =.027), while sinusitis was noted to be significantly more common among the adult group (P =.019). Transnasal endoscopic removal of ACPS was performed in 12 (63.1%) children and 11 (68.7%) adults. A combined open/endoscopic approach was required in 36.9% of children and 31.3% of adults. On histologic examination, allergic ACPS (the mucosal surface is respiratory epithelium, no mucus glands, abundant eosinophils) was more common than inflammatory ACPS (the mucosal surface is respiratory epithelium, no mucus glands, abundant neutrophils) in children (2.8:1) as compared to adults (0.8:1) (P =.045). All of our patients were followed with endoscopic examination for a period ranging from 9 to 42 months (mean, 24 months). Recurrence of ACPS was identified in 2 children and 1 adult.

CONCLUSION:

Antrochoanal polyps are a rare clinical entity. Children have unique clinical and pathological features as compared to adults. Endoscopic excision is safe and effective in the pediatric age group and has the capability to ensure complete removal and lower recurrence rate.

An unusual case of antrochoanal polyp with sudden laryngeal dyspnoea and stridor onset

Antrochoanal polyps usually present with nasal obstruction. An exceptional case is described occurring in an elderly patient with sudden laryngeal dyspnoea and stridor due to an antrochoanal polyp. The symptoms were so serious that an emergency surgical procedure was mandatory. A 14 cm antrochoanal polyp was excised in toto in endoscopy through the right nostril.