DYSPHAGIA AS A UNIQUE PRESENTATION

OF GIGANTIC ANTROCHOANAL POLYP

Mohd Hadzrie Mohd Hamdan, Khairunnisak Misron,
Syed Zaifullah Syed Hamzah, Ammar Hazwan Zainal Ariffin, Masniah Sukiman
Department of Otorhinolaryngology, Tawau Hospital, Sabah
CR 3
INTRODUCTION
Figure 1:
Antrochoanal polyp is a clinical entity of benign polypoid
lesion arising from maxillary sinus mucosa through the ostium, Oropharyngeal
that reaches the choana via the internal naris and examination showed
nasopharynx, and may extend to the oropharynx. Although a large hanging mass
nasal obstruction is the most common symptom, we reported arising from post
a case of huge antrochoanal polyp who presented with
dysphagia as an initial manifestation.
nasal space
extending downward
CASE PRESENTATION to oropharynx

A 16-year-old girl presented to Emergency Department with sudden onset of difficulty

of swallowing for two days associated with intraoral mass. She also complaint of
chronic nasal blockage and snoring. There was neither shortness of breath nor FIGURE 1
hoarseness. On examination, she was not in respiratory distress. Oral examination
revealed a lobulated mass occupying the oropharynx seemed arising from postnasal
space. Rigid nasoendoscopy showed unilateral nasal mass obstructing the whole right
nasal cavity.
ANTRAL Aggressive sinonasal tumor was part of our concerned, hence urgent computed
tomography of paranasal sinuses requested. It showed soft tissue density causing
complete obstruction of the right nasal cavity extending downward to the oropharynx,
almost blocking the airway patency. Emergency Endoscopic Sinus Surgery was
performed to extirpate the polyp. The antral part of polyp was removed via nostril while
the choanal part was retrieved orally. The polyp measured 10x7cm. Histopathological
examination confirmed antrochoanal polyp by presence of normal respiratory
epithelium with fibrosis stroma. Repeated rigid nasoendoscopy six months post
operation revealed no evidence of recurrence

FIGURE 2 DISCUSSION
Antrochoanal polyp is postulated to be caused by chronic inflammatory process. Although
antrochoanal polyp is a benign condition, if left untreated can lead to serious obstruction
CHOANAL to upper aerodigestive tract as well as upper respiratory tract. It may come with upper
Figure 2: respiratory airways obstruction. Radiological imaging is needed to delineate the nature
and extend of the lesion. Complete surgical removal is the mainstay of the treatment.
Besides the classical barbaric surgical technique like Caldwell Luc operation, the fuctional
The antral and endoscopic sinus surgery (FESS) has recently applied in most of the cases. The essence of
choanal part of the surgical approach is the ability to visualize maxillary sinus cavity and total removal of
polyp. antrochoanal polyp components. Insufficient surgery results in recurrence
CONCLUSION
Even though antrochoanal polyp is a common benign lesion, it can take a worse shape, usually when neglected. A
huge polyp can be life threatening if not treated early. Antrochoanal polyp must be included in differential
diagnosis of sinonasal tumor. Early referral to Otorhinolaryngology (ORL) unit is needed for diagnostic
nasoendoscopy.

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