Antrochoanal polyp displacing the uvula and the soft palate. (Rhinoscopic Clinic).

A 35-year-old man complained of a foreign-body sensation in his mouth that had been present for approximately 6 months. The sensation was associated with difficulty breathing through his left nostril.

Computed tomography (CT) of the sinuses demonstrated an almost complete opacification of the left maxillary sinus and the presence of a soft-tissue mass in the posterior left nasal cavity that extended into the right side of the nasopharynx (figure, A). Examination of the mouth revealed that a large polypoid mass was hanging from the nasopharynx (figure, B). This mass had anteriorly and superiorly displaced the uvula and soft palate, both of which were edematous. The mass was mobile on palpation with a tongue depressor. On examination with a nasal speculum, the nasal cavities appeared to be normal. However, nasal endoscopy detected a whitish soft-tissue mass in the posterior nasal cavity that appeared to arise from the left middle meatus (figure, C). On palpation with a suction tube, the mass was mobile. A diagnosis of an antrochoanal polyp was made.

The patient was taken to the operating room for an endoscopic excision of the polyp. Telescopic examination of the left nasal cavity confirmed that the mass in the posterior nasal cavity had originated in the left middle meatus. After the intranasal component of the mass was separated, the nasopharyngeal portion was grasped with a large cup forceps and removed via the oral cavity (figure, D). Attention was refocused on the left nasal cavity. The stalk of the antrochoanal polyp was found to be protruding from the natural ostium of the left maxillary sinus. The uncinate process was removed, and the natural maxillary sinus opening was enlarged with a backbiter and microdebrider. The left antrum was found to be filled with the polypoid mass, which was removed with a microdebrider and cup forceps. The origin of the polyp was determined to be the posteroinferior wall. The area was cleaned out with the microdebrider. Postoperatively, the patient did very well and experienced complete relief of his nasal airway obstr uction.

This case is an interesting example of a unilateral antrochoanal polyp that resulted in an anterior and superior displacement of the uvula and soft palate. Antrochoanal polyps typically appear as smooth, gray or bluish intranasal masses that arise from the ipsilateral maxillary sinus. They are usually passed into the nasal cavity through the natural or accessory sinus ostium by a pedicled stalk. The mass can exit from the postsurgical middle or inferior meatal window.(1) The antral component can be cystic or polypoid, and it can extend into the nasopharynx or, in rare cases, the oropharynx. (2)

An antrochoanal polyp can be successfully removed via endoscopic transnasal excision. The choanal (nasopharyngeal) portion of the polyp can be removed either transnasally or transorally. If the polyp extends into the oropharynx, it is easier to remove via transoral excision. The antral component of the polyp can be removed endoscopically via a middle meatal antrostomy with a 30[degrees] 45[degrees], or 70[degrees] telescope, amicrodebrider, and angulating cup forceps. if intranasal removal of an antral polyp proves to be technically difficult, a mini-Caldwell-Luc approach can be useful. (2)

References

(1.) Yanagisawa E. Atlas of Rhinoseopy: Endoscopic Sinonasal Anatomy and Pathology. San Diego: Singular Thomson Learning, 2000.

(2.) Yanagisawa E, Saizer SJ, Hirokawa RH. Endoscopic view of antrochoanal polyp appearing as a large oropharyngeal mass. Ear Nose Throat J 1994;73:714-15.

From the Department of Otolaryngology, University of South Florida College of Medicine, Tampa, and the Halifax Medical Center, Daytona Beach, Fla. (Dr. Christmas); and the Section of Otolaryngology, Hospital of St. Raphael, New Haven, Conn., and the Section of Otolaryngology, Yale University School of Medicine, New Haven (Dr. K. Yanagisawa and Dr. E. Yanagisawa).