Antrochoanal polyp among children: A review

Abstract

Antrochoanal polyp (ACP) or Killian polyp originates from the inflamed and edematous mucosa of the maxillary sinus. The etiopathogenesis of the ACPs is not clear. It has two components such as antral one which is always cystic and the nasal part is solid. The expanded intramural cyst enlarges to the point that it completely occupies the maxillary sinus, emerging through the natural ostium into the nasal cavity and extending towards the choana. The common clinical presentations are nasal obstruction and nasal discharge. Diagnostic nasal endoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI)are needed for making the diagnosis and the treatment planning. Surgery is indicated for the treatment of ACP. The endoscopic technique consists of an uncinectomy and resection of the polyp and its attachment to the maxillary sinus via a wide middle meatal antrostomy. Endoscopic sinus surgery via middle meatal antrostomy combined with trans-canine sinuscopy ensures the complete removal of the antral part of the ACP in children. The use of a microdebrider through the canine fossa is helpful to resect a broad attachment of the ACP in the maxillary sinus and it may be indicated as complementary to endoscopic sinus surgery. Simple avulsion of the ACP has a high chance of recurrence, whereas the Caldwell Luc procedure is associated with damage to the maxillary and dental growth centers. More research is needed for establishing the exact etiopathology and newer treatment options for ACPs.