B-ENT, 2007, 3, 97-99

Bilateral antrochoanal polyps in an adult: a case report

Y. F. Yilmaz, A. Titiz, M. Özcan, M. S. Tezer, S. Ozlugedik and A. Ünal
Clinic, Ankara Numune Teaching and Research Hospital, Ankara, Turkey

Key-words. Nasal polyps; maxillary sinus; endoscopic sinus surgery

Abstract. Bilateral antrochoanal polyps in an adult: a case report. Antrochoanal polyps (ACP) are almost always uni-
lateral. Only two bilateral cases have been reported to date, both of them in children. There have been no investigations
of the aetiology of the bilateral occurrence of these lesions, possibly due to the rarity of bilateral ACPs. In this paper, we
report on the first adult case of bilateral ACPs and review the literature.

Introduction
Antrochoanal polyps (ACP) are
benign solitary polypoid lesions
that originate from the maxillary
sinus mucosa and extend into the
choana through the sinus ostia.
They are usually seen in child-
hood and adolescence. They con-
stitute 4-6% of all nasal polyps
and are slightly more frequent in
males.
ACPs are almost always uni-
lateral. To our knowledge, only
two bilateral cases have been
reported in the English-language
literature to date. Both of those
cases were children. In this report,
we report on the first adult case of
bilateral ACPs.
Case report
A 24-year-old female was admit-
ted to our otorhinolaryngology
polyclinic. She complained of
difficulty with nasal breathing,
snoring, bilateral purulent nasal
discharge and a foreign-body
sensation in her throat. She did not
have any history of drug hyper-
sensitivity or bronchial asthma.
Bilateral greyish polypoid
masses were seen on anterior
rhinoscopy. The polyps filled both
nasal cavities. The stalks of the
polyps could be seen behind the
uncinate process during endo-
scopic examination. The polyps
were filling the nasal cavities,
passing through the choanae and
extending into the nasopharynx.
Paranasal sinus CT identified
soft tissue masses filling the
maxillary sinuses and extending
through the middle meatus into
the choanae on both sides
(Figures 1,2). Endoscopic surgery
was employed, starting with
uncinectomy. The stalks of the
polyps passed through enlarged
natural ostia of the maxillary
sinuses on both sides. Following
the removal of the intranasal
polyps and their stalks, it was
possible to remove the antral
parts through the enlarged ostia
(Figure 3). The histopathological
report was “benign inflammatory
nasal polyp” for both lesions.
No recurrence was observed in
a 12-month follow-up period.
Discussion
ACPs constitute 28-33% of nasal
polyps in childhood, although
they are seen less frequently in
adults.1,2 Bilateral ACPs are
extremely rare. Only two cases
have been reported to date, both in
12-year-old children. Our case is
the first adult with bilateral ACPs.
The aetiology of ACPs is not
clear. Chronic infection and aller-
gy are reported as the possible
aetiological factors. Some authors
reported allergy in 50-69% of
cases, while some others noted an
increased incidence of ACPs in
children with chronic sinusitis.2-4
Chen et al.2 suggested that
ACPs could be a complication
of chronic sinusitis. Furthermore,
the bacterial flora of ACPs are
similar to other inflammatory nasal
polyps.5 ACPs are more frequent
in patients with cystic fibrosis.1
ACPs are almost always uni-
lateral, although it is not known
why. None of the possible aetio-
logical factors mentioned above,
namely allergy and chronic sinusi-
tis, can explain unilateral occur-
rence. We have not found any
investigations of this topic in our
review of the literature, possibly
due to the rarity of bilateral ACPs.
Berg et al.6 posited the occur-
rence of enlarged intramural cysts
protruding into the nasal cavity
and passing through the sinus
ostium that later become poly-
pous. However, this hypothesis is
also inadequate as an explanation
98 Y. F. Yilmaz et al.

Figure 1 Figure 2
The coronal CT showing soft tissue masses filling bilateral Bilateral polypoid masses extending into choanae and oro-
maxillary sinuses. pharynx through middle meatus on both sides.

for the unilateral occurrence of

ACPs because, although bilateral
maxillary cysts are frequent, the
contralateral maxillary sinus is
almost always normal in patients
with ACPs. The co-existence of
more than one choanal polyp has
been reported only once.7
The most frequent symptom of
ACPs is nasal obstruction fol-
lowed by snoring, sleep apnoea,
epistaxis, dyspnoea, dysphagia
and weight loss.4 The symptoms
of our patient were nasal obstruc-
tion, purulent nasal discharge and
foreign-body sensation in the Figure 3
throat. Macroscopic view of excised antrochoanal polyps
ACPs are treated surgically.
Simple polypectomy, a Caldwell-
Luc procedure and endoscopic cedure provides a wide exposure dren. The risk of injury to the
sinus surgery (ESS) may be and enables the complete removal infra-orbital nerve is minimal and
employed for surgical removal. of the pathological tissues in the the healing period is shorter with
Most surgeons prefer simple maxillary sinus. However, the this procedure.10 Some studies
polypectomy in children younger removal of the ostial portion may have reported success with the
than 8 years of age since the be awkward. Tooth roots may be endoscopic canine fossa
development of maxillary sinuses damaged and development of the approach.13 However, we were
and teeth has not been completed maxilla may be disturbed.8,9 able to remove the antral part
at that age. However, recurrence is Lately, most surgeons have completely through the enlarged
common with a simple polypecto- started to prefer ESS for the sinus ostia and have not employed
my.1,8,9 removal of ACPs.10-12 Tooth-root canine fossa endoscopy.
Recurrence is unusual with a damage is avoided in ESS and so One of the two patients with
Caldwell-Luc approach. This pro- this approach may be used in chil- bilateral ACPs underwent ESS
Bilateral antrochoanal polyps
and the other underwent a
Caldwell-Luc procedure for surgi-
cal removal.14,15 Neither patient
suffered any recurrence in the six
months postoperative. We used
ESS in our patient and the patient
was free of recurrence in the
twelve months postoperative.
In conclusion, this paper pre-
sents the first case of an adult
patient with bilateral ACPs. She
was treated successfully with
ESS. The rarity of this phenome-
non precludes any explanation of
the bilateral occurrence.
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Yavuz Fuat Yilmaz, M.D.
Fatih cad. 178/ 10 Kecioren
Ankara, Turkey
Tel.: +90 (0 505) 764 74 01
E-mail: dryfyilmaz@yahoo.com.tr