scholarly journals Antrochoanal Polyp: Updated Clinical Approach, Histology Characteristics, Diagnosis and Treatment

2021 ◽  
Author(s):  
Warman Meir ◽  
Rona Bourla ◽  
Monica Huszar ◽  
Elchanan Zloczower
Keyword(s):  
Maxillary Sinus ◽  
Nasal Polyps ◽  
Squamous Metaplasia ◽  
Complete Removal ◽  
Cyst Formation ◽  
Endoscopic Examination ◽  
Sinus Surgery ◽  
Antrochoanal Polyp ◽  
Inflammatory Reactions ◽  
Male Predominance

Antrochoanal polyp (ACP) is a benign unilateral polyp, originating from the maxillary sinus and expanding through the accessory or natural ostia into the nasal cavity and choanae. It has a 2: 1 male predominance and is more common in children and young adults. The exact pathophysiology is unclear, and it is thought to have less of the inflammatory reactions as opposed to typical bilateral nasal polyps which are commonly seen in diffused chronic rhinosinusitis. The presenting symptoms of ACP are unilateral nasal obstruction and rhinitis. Epistaxis, pain, and foul-smelling secretions are not typically seen and point towards a different etiology. Diagnosis is mainly clinical via endoscopic examination and supported by Computed tomography (CT) imaging. In CT images the three components of the polyp can be identified; an intramaxillary portion, intranasal and choanal components. Treatment is surgical, where Endoscopic sinus surgery (ESS) is the main technique used with other assisting approaches to reach the more challenging anterior and inferior areas of the maxillary sinus. Successful resection depends on complete removal of the intramaxillary component of the polyp to avoid polyp regrowth. The typical histologic characteristics are cyst formation, fibrosis and squamous metaplasia that are significantly more common in ACP than diffused nasal polyps.

scholarly journals Bilateral antrochoanal polyp: case report, literature review and clinical guidelines

New Medicine ◽  
2018 ◽  
Vol 22 (4) ◽  
Author(s):  
Agata Wasilewska ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Maxillary Sinus ◽  
Complete Removal ◽  
Paediatric Population ◽  
Sinus Surgery ◽  
Antrochoanal Polyp ◽  
Benign Lesions ◽  
Endoscopic Control ◽  
High Incidence ◽  
Sinus Ostium

Antrochoanal polyps are unilateral benign lesions that arise within the maxillary sinus antrum. The purpose of this study was to review the clinical characteristics and treatment of antrochoanal polyp (ACP). A retrospective analysis was performed to investigate the case of one patient with an extremely rare bilateral polyp with a high incidence of recurrence. ACPs account for approximately one-third of polyps occurring in children. Most of them are unilateral. The recurrent course of ACP is more prevalent in the paediatric population than in adults. ACPs require differential diagnosis with malignancies. The mainstay of treatment is surgery. The gold standard is endoscopic sinus surgery with complete removal of polyp mass under endoscopic control and widening of the maxillary sinus ostium via the middle meatus. Postoperative follow-up of at least 2 years is very important to monitor patients for recurrence.

Antrochoanal Polyposis: A Review of 33 Cases

1993 ◽  
Vol 72 (6) ◽  
pp. 401-411 ◽  
Author(s):  
Paul R. Cook ◽  
William E. Davis ◽  
Robert McDonald ◽  
Joel P. McKinsey
Keyword(s):  
Multivariate Analysis ◽  
Data Analysis ◽  
Allergic Disease ◽  
Nasal Polyp ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Antrochoanal Polyp ◽  
Chi Square ◽  
Clinical Behavior

We report on a series of 33 consecutive cases of antrochoanal polyp (ACP) treated by endoscopic sinus surgery over a five-year period. All but one patient was treated by endoscopic sinus surgery alone. This method of treatment was quite effective for ACPs. These 33 patients represent 22.3% of all nasal polyp patients on whom we operated during the same period. This incidence of ACP is greater than that generally reported in the literature. Some authors have attempted to distinguish ACPs from common nasal polyps primarily on the basis of morphology, histology, and the clinical behavior of the ACPs. In our series, a multivariate analysis, including histopathologic correlation, did not support the notion that ACPs are clearly distinct from common nasal polyps. Some interesting differences between the polyp groups did, however, become evident in our data analysis. Generally, ACPs are not thought to be associated with allergic disease; however, in our series we found the association of allergic disease with ACPs to be statistically significant (Chi-square=4.575, p<.05).

scholarly journals Disease Management in the Fungal Body of the Maxillary Sinus in People with Planned Dental Implantation

2021 ◽  
Vol 6 (3) ◽  
pp. 206-211
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
Keyword(s):  
Maxillary Sinus ◽  
Complete Removal ◽  
Sinus Surgery ◽  
Endoscopic Endonasal ◽  
Main Method ◽  
Maxillary Bone ◽  
Fungal Ball ◽  
Dental Implantation ◽  
Group 2 ◽  
Maxillary Sinuses

The fungal ball is the most common clinical form of fungal etiology sinusitis. The main method of treatment of patients with this pathology is surgery. Achieving complete removal of the fungal body is important, especially in patients who will have planned dental implantation. Among the accesses to the maxillary sinus in cases of the fungal body of the sinus, the most common one is through the middle meatus, but it does not provide visual control of the anterior parts of the sinus during the intervention. The use of modified infraturbinal access provides better opportunities for examination of the anterior parts of the maxillary sinus. The purpose of the study is to increase the effectiveness of surgical treatment of patients with fungal bodies of the maxillary sinus by optimizing access during endoscopic endonasal intervention. Materials and methods. The data of 113 patients with fungal ball of maxillary sinuses who underwent sinusotomy in preparation for dental implantation were analyzed. Cone beam computed tomography of paranasal sinuses of patients were performed twice – before functional endoscopic sinus surgery and before subantral augmentation of the maxillary bone. Group 1 included 78 patients to whom the fungal balls were removed from the sinus through the middle nasal meatus, group 2 – 35 patients to whom, in cases when it was impossible to visually confirm the completeness of removal of the fungal ball from the anterior area of the sinus, an additional infraturbinal approach was performed in our modification. Results and discussion. According to tomography before rhinosurgery it was established that "blackout" of more than 60% of the sinus space is observed in 50.5% of patients with fungal bodies, with the vast majority of patients (88.1%) fungal bodies in the maxillary sinus are located in its lower parts and spread forward from the nasolacrimal canal level. During sinus rehabilitation, the need for additional infraturbinal access arose in 5 (14.3%) patients of the second group. As a result of its performance in all 5 operated patients polyposis-altered tissues were found in "blind zones" and in 2 (5.7%) – there were also remains of a fungal body. Residual fungal bodies in the maxillary sinus were detected in 3 (3.9% CI 95% – 0.01; 11.6) patients of the first group, and were not observed in the second group. All cases of residual fungal masses in the sinus were not accompanied by specific complaints. A revision of sinusitis with fungal masses removing was performed on 3 patients due to the appearance of residual fungal bodies by preformed antrostomy with local anesthesia. Conclusion. Anthrostomy using additional endoscopic infraturbinal access when removing the fungal body from the lower anterior maxillary sinus is the optimal combined access that allows maximum visualization of the maxillary sinus and avoid recurrence of the disease

scholarly journals Pathomorphological Features of the Mucoperiostasis of the Processus Uncinatus in Discrete Diseases of the Maxillary Sinus

2021 ◽  
Vol 6 (5) ◽  
pp. 255-262
Author(s):  
Ya. V. Shkorbotun ◽  
◽  
O. G. Kuryk ◽  
◽  
Keyword(s):  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Sinus Surgery ◽  
Histological Features ◽  
Dental Implantation ◽  
Ostiomeatal Complex ◽  
History Of ◽  
Group 3 ◽  
Group 2

The state of the mucoperiostasis of the maxillary sinus is one of the important factors that affect the effectiveness of dental implantation, especially in case of need for augmentation of the maxillary bone. Chronic rhinosinusitis with nasal polyps, chronic rhinosinusitis with fungal bodies, and sinus cysts are among the most common pathological processes in the maxillary sinus that are encountered when performing subantral augmentation. In addition, a separate category of patients is made up of those with a history of sinus surgery in their anamnesis. The condition of sinus mucoperiosteum can be estimated based on results of processus uncinatus research, because it has a similar histological structure, directly contacts with all maxillary sinus excretion and, as usual, gets removed while endoscopic sinusotomy. The purpose of the work was to study the histological features of mucoperiostasis and adjacent bone in the ostiomeatal complex in discrete diseases of paranasal sinuses: chronic rhinosinusitis with nasal polyps, maxillary sinus cysts, fungal balls and postoperative scar changes in the ostium. Materials and methods. Histological features of processus uncinatus fragments removed during endoscopic interventions in 45 patients were investigated: with sinus cysts – 12 patients (group 1), chronic rhinosinusitis with nasal polyps – 13 patients (group 2), sinus fungal body – 13 patients (group 3) and postoperative scarring changes in the ostiomeatal complex – 7 patients. The condition of the epithelial layer of the mucoperiosteum, the structure of its own plate, the periosteal layer and the bone to be treated were evaluated. Results and discussion. In 91.67 ± 0.08% of patients with maxillary sinus cysts, there were no changes in the mucoperiostasis and the bone of processus uncinatus. Most patients in groups 2 and 3 showed mucoperiostal edema with a predominant reaction of the mucosal layer and lamina propria. Fibrous changes of the processus uncinatus were most often detected after the intervention was performed at 71.43 ± 0.13% and in chronic rhinosinusitis with nasal polyps – 53.85 ± 0.14%. This confirms the significance of the mucoperiostasis injury factor with the underlying bone for the development of gross adhesive changes between the periosteum and bone tissue. Osteitis of the processus uncinatus was detected in 38.46 ± 0.13% of patients in group 2, 15.38 ± 0.1% in group 3, and 28.57 ± 0.17% in group 4. Conclusion. Signs of periostitis and processus uncinatus osteitis were most often detected in patients with neutrophilic mucoperiosteum infiltration in chronic rhinosinusitis with nasal polyps and in fungal balls sinus. History of surgery with periosteal and bone trauma promotes scarring and results in a tight connection between bone and periosteum, which can be regarded as a risk factor in relation to the rupture of the later in its peeling off during sinus lifting procedure. Therefore, when performing surgery on the maxillary sinus, in order to maintain conditions for possible dental implantation, excessive trauma of the periosteal layer of mucoperiosteum should be avoided

The Incidence of Complications after Canine Fossa Puncture Performed during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (2) ◽  
pp. 203-206 ◽  
Author(s):  
Simon R. Robinson ◽  
Robert Baird ◽  
Tong Le ◽  
Peter John Wormald
Keyword(s):  
Maxillary Sinus ◽  
Facial Pain ◽  
Complete Removal ◽  
Sinus Surgery ◽  
Canine Fossa ◽  
Number Of Patients ◽  
Facial Numbness ◽  
Cheek Swelling ◽  
Made In

Background Patients with extensive disease affecting the maxillary sinus may require a canine fossa approach for complete removal of disease. This study was designed to determine the complications associated with this procedure. Methods We performed a retrospective study of 21 patients who had undergone a canine fossa puncture at an academic hospital complex in Adelaide, Australia. Results A total of 37 canine fossa punctures were made in 21 patients. Twenty-eight of the 37 (75.7%) sides in which a canine fossa puncture was performed experienced a complication. The most common complaint was of cheek swelling in 14 (38%) followed by facial pain in 12 (32%), facial numbness in 11 (30%), cheek pain in 10 (27%), dental numbness in 10 (27%), gingival complications in 9 (24%), and facial tingling in 6 (16%) of sides. Most complications (75.5%) resolved within the 1st month after surgery. Six patients (28.6%) had persistent complications with facial tingling in 3 patients (50%) followed by facial numbness and tingling in 1 patient (11%), facial numbness alone in 1 patient (8.3%), and facial pain in 1 patient (7.1%). Conclusion Canine fossa antrostomy is a technique that provides additional access to the maxillary sinus. Surgeons need to be aware that, although minor, a significant number of patients will experience both transient and long-term complications.

scholarly journals Woakes’ syndrome: Case report

2021 ◽  
Vol 11 (42) ◽  
pp. 81-87
Author(s):  
Lucian Lapusneanu ◽  
Cristina Andrei ◽  
Daniela Mihalache ◽  
Luciana Lapusneanu
Keyword(s):  
Case Report ◽  
Nasal Polyps ◽  
Clinical Case ◽  
Endoscopic Examination ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Rare Entity ◽  
Therapeutic Protocol ◽  
Favourable Evolution ◽  
Nasal Pyramid

Abstract Woakes’ syndrome is a rare entity, defined as severe recurrent chronic rhinosinusitis with nasal polyps, which has as a consequence the deformation of the nasal pyramid, produced by the continuous pressure and the inflammation maintained by the size of the polyps. This paper reviews the main features of Woakes’ syndrome by describing a clinical case. The patient presented to the ENT Outpatient Clinic for aggravation of an obstructive nasal respiratory syndrome, associated with rhinor-rhea, headache, anosmia and deformity of the nasal pyramid. The ENT clinical examination, the nasal endoscopic examination and the craniofacial CT scan established the diagnosis of Woakes’ syndrome. Functional endoscopic sinus surgery was performed. The follow-ups performed at 10 days and later, a month after surgery, showed a favourable evolution, without signs of local recurrence and a narrowing of the nasal pyramid compared to the preoperative moment. Proper management and proper adherence to the therapeutic protocol are factors that can prevent the onset of this syndrome.

scholarly journals Transnasal Marsupialization Using Endoscopic Sinus Surgery for Treatment of Keratocystic Odontogenic Tumor in Maxillary Sinus

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Masafumi Ohki
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Complete Removal ◽  
Odontogenic Tumor ◽  
Sinus Surgery ◽  
Surrounding Tissue ◽  
Nasal Discharge ◽  
Keratocystic Odontogenic Tumor ◽  
Impacted Tooth ◽  
The Right

Objective.We report the first utilisation of transnasal marsupialization to treat a keratocystic odontogenic tumor in the maxillary sinus of a 37-year-old man.Case Report.A 37-year-old man presented with a nasal discharge and right odontalgia. Computed tomography revealed an expanding cystic lesion with a calcificated wall containing an impacted tooth in the right maxillary sinus. The diagnosis was keratocystic odontogenic tumor. Transnasal marsupialization was performed using endoscopic sinus surgery to enlarge the maxillary ostium and remove a portion of the cystic wall. Pathological findings included lining squamous epithelium and inflammation. The remaining tumor shrank, becoming free of infection after surgery, without proliferation.Conclusion.Transnasal marsupialization using endoscopic sinus surgery is effective in treating keratocystic odontogenic tumors. It offers minimal surgical invasion and reductive change, making it advantageous for complete removal with fewer complications in the bones and surrounding tissue in the case of secondary surgery.

Combined approach for paediatric recurrent antrochoanal polyp: a single-centre case series of 27 children

2019 ◽  
Vol 133 (7) ◽  
pp. 627-631 ◽  
Author(s):  
E Mantilla ◽  
P Villamor ◽  
C De La Torre ◽  
H Álvarez-Neri
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Case Series ◽  
Complete Removal ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Correct Identification ◽  
Antrochoanal Polyp ◽  
Combined Approach ◽  
Retrospective Case ◽  
Polyp Recurrence

AbstractObjectiveTo compare functional endoscopic sinus surgery with a combined approach (functional endoscopic sinus surgery plus Caldwell–Luc procedure) for the treatment of paediatric antrochoanal polyp, in terms of antrochoanal polyp recurrence and safety.MethodThis retrospective case series comprises 27 paediatric patients with recurrent antrochoanal polyp, treated from January 2010 to January 2018.ResultsThe average age of the patients at the time of diagnosis was 10.4 ± 2.49 years. The recurrence rate after functional endoscopic sinus surgery alone was 72.9 per cent, compared with 12.5 per cent after functional endoscopic sinus surgery plus the Caldwell–Luc procedure (p < 0.00001). No complications were reported during surgery or follow up.ConclusionThe correct identification of the origin of the antrochoanal polyp and an adequate returning of maxillary ventilation by widening the ostium can prevent recurrences. Although functional endoscopic sinus surgery continues to be the ‘gold standard’ for antrochoanal polyp treatment, in cases of revision surgery, a combined approach could ensure the complete removal of the polyp through the two openings.

scholarly journals The role of functional sinus surgery for treatment of antrochoanal polyp

2007 ◽  
Vol 54 (2) ◽  
pp. 69-73
Author(s):  
I. Pendjer ◽  
Z. Dudvarski ◽  
Lj. Janosevic ◽  
A. Mikic ◽  
Z. Vujicic
Keyword(s):  
Maxillary Sinus ◽  
Benign Lesion ◽  
Maxillofacial Surgery ◽  
Pathological Process ◽  
Sinus Surgery ◽  
Antrochoanal Polyp ◽  
Ct Findings ◽  
Canine Fossa ◽  
Clinical Center ◽  
Minimal Damage

Antrochoanal polyp (ACP) is a benign lesion which arises from the mucosa of maxillary sinus, fills it and expands through natural ostium towards choana protruding in the epipharynx. Objective: to present our experience in endoscopic surgery of ACP. Material and methods: prospective study included 24 patients operated at the Institute of Otorinolaryngology and Maxillofacial surgery, Clinical Center of Serbia, Belgrade, in the period 2002- 2004. Subjective symptoms, endoscopic and CT findings were evaluated postoperatively, following up the patients in the period 12-20 months. Subjective difficulties of patients were tested by 100mm-analogue scale, while endoscopic and CT findings were demonstrated by three-stage scale from 0 to 2. Applying the technique of ACP extraction in Trendelenburg?s position and approaching the part which protrudes in the epipharynx, we successfully removed the endonasal part by means of curved forceps for epipharyngeal biopsy. By endoscopic middle meatotomy, the natural ostium of maxillary sinus was expanded and pathological process from the very sinus was successfully removed. Results: only one female patient had the majority of symptoms after the operation, while all others had no complaints. Endoscopic and CT findings were normal in all patients at the latest control, without any signs of ACP recurrence. There were no intraoperative or postoperative complications. Conclusion: minimal damage to sinus mucosa due to forceps is lesser problem than complications developed upon creating even the miniature opening in the canine fossa. Using this technique, a dexterous surgeon may successfully extract pathological process with minimal incidence of recurrence, and, more important, with no complications and maximally fast recovery of patients. .

Histopathologic Features of Chronic Sinusitis Precipitated by Odontogenic Infection

2018 ◽  
Vol 33 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Anish Raman ◽  
Peter Papagiannopoulos ◽  
Hannah N. Kuhar ◽  
Paolo Gattuso ◽  
Pete S. Batra ◽  
...  
Keyword(s):  
Nasal Polyps ◽  
Chronic Sinusitis ◽  
Squamous Metaplasia ◽  
Disease Process ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Severe Inflammation ◽  
Sinonasal Outcome Test ◽  
Inflammatory Profile ◽  
Histopathologic Features

Background Chronic rhinosinusitis (CRS) is a heterogeneous disease process that can arise in the context of odontogenic disease from the maxillary teeth. The histopathologic features of odontogenic CRS (CRSo) have yet to be determined and may have important implications on disease management and need for escalation of therapy. Objectives The objectives of this study are to characterize the histopathologic features of CRSo and determine whether the inflammatory profile of CRSo contributes to its recalcitrance to medical therapy and need for surgery in a subset of patients with this disease. Methods A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables, Lund–Mackay scores (LMS), and Sinonasal Outcome Test-22 scores were compared among CRSo patients, CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients. Results Twenty-three CRSo, 38 CRSwNP, and 53 CRSsNP patients who underwent FESS were analyzed. Compared to CRSsNP, CRSo exhibited increased moderate–severe inflammation (73.9% vs 41.5%, P < .009). Compared to CRSwNP, CRSo had decreased squamous metaplasia (0.0% vs 18.4%, P < .03) and decreased fibrosis (26.1% vs 63.2%, P < .005). Eosinophilia was prevalent in CRSo but to a lesser extent than in CRSwNP (39.1% vs 63.2%, P < .05). CRSo cases had significantly lower mean LMS compared to CRSwNP (7.83 ± 2.77 vs12.18 ± 6.77, P < .005). Conclusion CRSo exhibits histopathologic features similar to those of CRSsNP with more severe inflammation. Moreover, eosinophilia, which is not typically considered to coexist with CRSo, was present in a large portion of CRSo patients. These findings may help explain at the inflammatory level why select cases of CRSo may be recalcitrant to medical and dental therapy.

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