Antrochoanal polyp

Antrochoanal polyp(synonym-Killian's polyp)

Arise from mucosa of maxillary antrum
Prolapse thru acc ostium into nasal cavity
Ostium directed backwards---grow towarda choana
Mostly u/l
Younger males

Aetiology:-
Exact– not known
Infection od sinuses with concurrent allergy
Proetz __may arise due to maldeveloped, large max sinus ostia

Site of origin:-
Arise from lateral wall or floor of max antrum
If large, obstructs entire nasopharynx---nasal onstruction b/l.

Has 3 parts:
Antral
Nasal and
choanal
The neck is that constricted part between antral and nasal part---site where it exits from the ostium

SYMPTOMS:-
Nasal obstruction:
Usually u/l, b/l if fills nasopharynx
Nasal discharge:
Mucoid –mucopurulent
Hyposmia and anosmia
changes of voice– hyponasality with loss of nasal resonance (rhinolalia clausa).
Fullness of ears and decreased hearing—
Due to obstruction of eust. tube,

Signs:-
May protrude through the nostril or hang down behind soft palate
A/R: normal in early stages
Later stages, polyp seen in post part of MM
Post rhinoscopy—smooth, greyish white,translucent, oedematous, spherical mass in the choana and nasopharynx on the affected side
Soft palate may be pushed forwards

Investigations:-
X-ray nose and PNS—haziness of the affected sinus
X-ray lat view of nasopharynx—mass in nasopharynx
A cresentic air column between the roof of nasopx and polyp is characteristic and differentiates it from angiofibroma, adenoma or mass from the roof of nasopharynx

Treatment:-
Surgical
Intranasal AVULSION polypectomy
FESS—endoscopic removal of polypalong with widening of the natural ostium
Caldwell-Luc operation—prior to FESS’opening of max antrum thru sublabial approach thru canine fossa and removal of the polyp and diseased mucosa
Not done in children—as dentition is incomplete

Differential diagnoss of nasal polyp:-
Hypertrophic inf turbinate
JNA
Meningoencephalocoele
Rhinosporidiosis
Inverted papilloma
Granulomatous lesions like TB
Malignant tumours of nose


Why polyp goes backward?
–Accesory ostium is posteriorly situated
–Ostium directed backwards
–Obliquity of posterior part of IT-polyp slides
–Negative pr. created during swallowing, etc.
Caldwell-Luc operation:-Its a surgical procedure for its treatment.



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