Antrochoanal Polyp
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👃 Antrochoanal Polyp
Antrochoanal polyp, also known as AC polyp, is a very common OPD case and an important long case in practical and viva exams.
📝 Definition of a Nasal Polyp
A nasal polyp is an inflammatory, non-neoplastic, hypertrophied, edematous mucosa prolapsing out of the nose or paranasal sinuses.
Two Types
1- Antrochoanal polyp
2- Bilateral ethmoidal polyp
📌 Antrochoanal Polyp
Also Known As 👉 Killian's Polyp
🔍 Origin
- Arises from the mucosa of the maxillary antrum, near the accessory ostium
- Prolapses out of the ostium into the middle meatus
- Grows in the nasal cavity and then towards the choana
What are the Parts of the Antrochoanal Polyp?
🔍 Etiology of Antrochoanal Polyp
Age Group
👉 Children and young adults
⭐ The exact cause is not known. It has been hypothesized that infection plays a greater role than allergy.
⭐ In contrast, ethmoidal polyp is more associated with allergy than infection.
Theories of Etiology
1- Proetz's Theory
2- Bernoulli's Phenomenon
3- Berg's Intramural Cyst Theory
4- Mill's Secretory Cyst Theory
5- Blocked Mucous Gland Theory
6- Jackson's Mucopolysaccharide (Ground Substance) Theory
7- Vasomotor Imbalance Theory
8- Infections
Describe the different theories of etiology of Antrochoanal Polyp in detail.
🔬 Pathology of Antrochoanal Polyp
Epithelium
- In early stages, covered by ciliated columnar epithelium, the same as normal nasal mucosa
- Later may undergo metaplastic change to transitional or squamous type, especially on exposure to atmospheric irritation
Submucosa
- Large intercellular spaces filled with serous fluid
- Infiltrated with round cells
🗣️ Clinical Features of Antrochoanal Polyp
Symptoms of Antrochoanal Polyp
- Unilateral Nasal Obstruction
- Nasal Discharge
- Post Nasal Drip
- Headache
- Rhinolalia Clausa
- Mouth Breathing
- Hyposmia or Anosmia
- Blocked Ears and Reduced Hearing
- Epistaxis
When can a patient of Antrochoanal Polyp have bilateral nasal obstruction?
Why does a patient of Antrochoanal Polyp complain of reduced hearing?
What is Rhinolalia Clausa and Rhinolalia Aperta? Give some examples for each.
What are the causes of Bleeding in an Antrochoanal Polyp?
Why does the Antrochoanal Polyp grow backwards?
Signs of Antrochoanal Polyp
Anterior Rhinoscopy
A solitary, unilateral, pale, glistening polypoidal mass with a smooth surface, which is mobile.
On Probing
- Soft in consistency
- ❌ Does not bleed on touch
- ❌ Insensitive to touch
- ✅ Probe can be passed all around
❌ Does not shrink on Vasoconstriction
Why is Antrochoanal polyp insensitive to touch?
How will you differentiate Antrochoanal polyp from Inferior Turbinate Hypertrophy?
⭐ Must be performed, as the antrochoanal polyp notoriously grows backwards.
- Globular mass filling the choana and nasopharynx
- A very large polyp may hang down behind the soft palate and present in the oropharynx
What is the differential diagnosis of a unilateral nasal mass? Mention the endoscopic findings of each one of them.
🧪 Investigations of Antrochoanal Polyp
1- Diagnostic Nasal Endoscopy
- Determines the site of origin of the polyp
- Assesses the extent of the polyp
- Identifies any additional pathology
2- X-ray Paranasal Sinuses
⭐ Not commonly done nowadays, as CT is preferred.
3- X-ray Nasopharynx (Lateral View)
- Globular swelling in the post nasal space
- Crescentic air column behind the polyp
What is Dodd's sign? What is the clinical significance of Dodd's sign?
4- CT Paranasal Sinuses
- Hypodense mass filling the maxillary antrum, extending into the nasal cavity and occupying the choana
- Assesses the origin and extent of the polyp
- Identifies any other pathology or anatomical abnormality
🩻 Treatment of Antrochoanal Polyp
⚠️ Surgery is the only treatment. There is no role of medical treatment.
Surgery of Choice
👉 Functional Endoscopic Sinus Surgery (FESS)
What are the steps of FESS for Antrochoanal Polyp?
What is the indication for Caldwell Luc Operation for Antrochoanal Polyp?
⭐ Prognosis
Prognosis is very good, and recurrence is uncommon with good surgery.
What is the Differential Diagnosis of Antrochoanal Polyp?
🧠 Viva Pearls
- A nasal polyp is an inflammatory, non-neoplastic, hypertrophied edematous mucosa prolapsing from the nose or paranasal sinuses.
- Antrochoanal polyp is also known as Killian's polyp.
- It arises from the mucosa of the maxillary antrum near the accessory ostium.
- Antrochoanal polyp is more associated with infection, while ethmoidal polyp is associated with allergy.
- Epistaxis is extremely rare in antrochoanal polyp.
- On anterior rhinoscopy it is a solitary, unilateral, pale, glistening, polypoidal mass with a smooth surface.
- It is insensitive to touch and does not shrink on vasoconstriction.
- Surgery is the only treatment; there is no role of medical management.
- FESS is the surgery of choice.
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