Antrochoanal Polyp

Antrochoanal Polyp (Killian’s Polyp)

This polyp arises from the mucosa of maxillary antrum near its accessory ostium, comes out of it and grows in the choana and nasal cavity. Thus it has three parts.:

Antral:which is a thin stalk
Choanal:which is round and globular
Nasal:which is flat from side to side

Aetiology

The exact cause is unknown, but nasal allergies and sinus infections are suspected. These polyps are mostly seen in children and young adults, and they are usually unilateral.

Symptoms

Unilateral nasal obstruction, which may become bilateral.
Voice changes such as hyponasality (thick and dull voice).
Mucoid nasal discharge may appear on one or both sides.

Signs

As the polyp grows posteriorly, it may be missed on anterior rhinoscopy. When large, it may appear as a smooth greyish mass covered with discharge. Posterior rhinoscopy may reveal a globular mass filling the choana or nasopharynx.

Differential Diagnosis

Blob of mucus: Appears similar to a polyp but disappears after blowing the nose.
Hypertrophied middle turbinate: Differentiated by its pink color and bony consistency.
Angiofibroma: Presents with recurrent nosebleeds and is firm, easily bleeding on probing.
Other neoplasms: These are fleshy, pink, friable, and tend to bleed.

Diagnostic Imaging

X-rays may show opacity in the involved antrum. A lateral view of the nasopharynx may reveal a globular swelling, distinguishable from angiofibroma by the presence of air behind the polyp. A non-contrast CT scan of the sinuses may help in assessing the extent of the polyp.

Treatment

The treatment of choice is endoscopic sinus surgery. This has superseded older methods like simple polypectomy and the Caldwell-Luc operation. Recurrence is uncommon after complete removal, but in case of recurrence, the Caldwell-Luc operation may be required for full removal and to address maxillary sinusitis.

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Antrochoanal Polyp

Antrochoanal Polyp