Antrochoanal polyp: a comparative study of endoscopic endonasal surgery alone and endoscopic endonasal plus mini-Caldwell technique

Abstract

Antrochoanal polyp (ACP) originates in the maxillary sinus. To diminish the regrowth rate of choanal polyp, a complete removal of the antral portion and its attachment is necessary. There are several methods for this purpose, but in this study two techniques were comparatively investigated. This retrospective study was conducted by analyzing the database of 40 operated patients for ACP, 19 of whom underwent an endoscopic endonasal removal of polyps and 21 experienced endoscopic endonasal surgery with mini-Caldwell operation. The two techniques were compared with regard to their complications and regrowth rate. It emerged that post-operative complications (bleeding, synechia, ostia stenosis) in both groups were mild and there was not any significant difference between the two groups. Out of 19 cases in the endoscopic endonasal surgery group, 4 had recurrences, while in the mini-Caldwell group we had no recurrence. (P = 0.042)). This result implies that, in order to prevent incomplete excision and recurrences, combined approaches (endoscopic endonasal surgery and mini-Caldwell) should be considered, particularly when the attachment site of the antral part of ACP is undetected.

Update on Select Benign Mesenchymal and Meningothelial Sinonasal Tract Lesions

“…By imaging, ACPs tend to be a single, unilateral expansile process, revealing nearly total maxillary sinus opacification, mucosal thickening, and mucus retention. The stalk of attachment within the medial wall is not usually identified by imaging, but a large, pedunculated polyp will expand into and fill the nasal cavity and/or pharynx [55,62,64,65]. Uncommonly, choanal polyps will arise from the sphenoid or ethmoid sinus, referred to as sphenochoanal or ethmochoanal polyps, revealing a stalk of attachment in the named sinus [61].…”

“…Uncommonly, choanal polyps will arise from the sphenoid or ethmoid sinus, referred to as sphenochoanal or ethmochoanal polyps, revealing a stalk of attachment in the named sinus [61]. Conservative combination endoscopic (Functional Endoscopic Sinus Surgery: FESS) and open surgery (miniCaldwell procedure) to include the stalk and sinus contents, seems to yield the lowest risk of recurrence [55,60,64], especially if the point of attachment cannot be identified.…”

Endoscopic surgery in pediatric recurrent antrochoanal polyp, rule of wide ostium

“…The most important factors affecting the choice of surgical approaches are the preference of the surgeon, the age of the patient and the presence of recurrent disease [23].…”

Paediatric traffic accident and obstructive sleep apnoea by antrochoanal polyps: Case report and literature review

“…Some proponents of functional endoscopic sinus surgery (FESS) favour endoscopic excision [26], meticulously tracking and resecting the origin of the polyp after meatotomy and eventually using a microdebrider [27]. Despite constant progress in new technologies in FESS [28], recurrence rates after purely endoscopic resections differ in studies between 0 and 21% [29][30][31]. If the ACPs originate from the inferior or anterior wall, a combined endoscopic and external approach is necessary in up to one third of the cases to completely remove the lesion [32].…”

“…If the ACPs originate from the inferior or anterior wall, a combined endoscopic and external approach is necessary in up to one third of the cases to completely remove the lesion [32]. Atighechi published a low recurrence rate following a combination of functional endoscopic sinus surgery and mini-Caldwell-approach [31] using an endoscope and a microdebrider by a transcanine sublabial approach of 5 mm  5 mm diameter.…”