Endoscopic view of a frontochoanal polyp. (Rhinoscopic Clinic).

A 79-year-old white man complained of recurrent left sinusitis of several months' duration. He said he had difficulty breathing through his left nostril, particularly at night. He felt that something moved when he blew his nose. He denied any nasal pain, nasal bleeding, or weight loss.

Endoscopic examination of the nose revealed a left septal deviation and bilateral hypertrophy of the turbinates. A long nasal polyp originated in the left frontal recess and extended down to the nasopharynx (figure). Suction examination revealed that the polypoid mass was mobile and nontender. Computed tomography (CT) of the sinuses demonstrated opacification of the frontal, maxillary, and ethmoid sinuses bilaterally. The mass in the left posterior cavity was superimposed on the inferior turbinate. No bony erosion was seen. Endoscopic sinus surgery was scheduled for excision of the frontochoanal polyp, but the patient canceled the surgery because of his precarious cardiac condition.

Diagnosis of a frontochoanal polyp is made by transnasal endoscopy. Anterior rhinoscopy can detect normal anterior nasal cavities, but it might not show the ostiomeatal complex, posterior nasal cavity, and choana. Unlike antrochoanal polyps, isolated frontochoanal polyps are not common.

Nasal endoscopy in this case allowed for the visualization of the superior portion of the frontochoanal polyps, which were then traced to the frontal recess. CT of the sinuses can help identify the origin and extent of such polyps, including involvement in the choana.

Treatment is surgical. Resection of frontochoanal polyps begins with amputation of the stalk with endoscopic scissors or a microdebrider. The inferior choanal portion of the polyp is removed with a grasping forceps transnasally. The superior portion is removed with a microdebrider. In extensive cases, intraoperative imageguidance technology might be helpful.

From the Southern New England Ear, Nose, Throat, and Facial Plastic Surgery Group, New Haven, Conn.; the Section of Otolaryngology, Yale University School of Medicine, New Haven; and the Section of Otolaryngology, Hospital of St. Raphael, New Haven.