Endoscopic approach in patients with choanal polyps

Year 2008, Volume: 18 Issue: 2, 74 - 78, 18.04.2008

Hüseyin Altun Ayşenur Meriç Murat Ceran Orhan Gedikli

Abstract

Objectives: We evaluated the results of endoscopic treatment for choanal polyps. Patients and Methods: Twelve patients 5 females, 7 males; mean age 25 years; range 10 to 49 years underwent endoscopic surgery for choanal polyps. Preoperatively, all the patients were evaluated with endoscopic nasal cavity and nasopharyngeal examination and computed tomography of the paranasal sinuses. In addition, serum total and specific IgE levels were measured and prick test was performed. There were seven antrochoanal 58% , two ethmochoanal 17% , two sphenochoanal polyps, and one patient 8% had a chonchachoanal polyp. Anterior ethmoidectomy and intranasal polypectomy were performed for ethmochoanal and sphenochoanal polyps, respectively. Two patients in whom antral part of the mucosa could not be clearly determined underwent transcanine sinoscopy. In all the patients, the mucosa giving rise to polyps was removed. Evaluations were made at one and six months and at the end of a year. Results: The most common symptoms were nasal obstruction 70% and nasal discharge 52% . Allergic tests were positive in two patients with antrochoanal polyps. The only complication was mild bleeding in two patients. No recurrences were encountered within a year follow-up. Conclusion: Endoscopic approach for choanal polyps can be applied at all ages and it is associated with low morbidity.

Keywords

Endoscopy, nasal obstruction/etiology, nasal polyps/radiography/surgery

Koanal polipli olgularda endoskopik yaklaşım

Abstract

Amaç: Koanal polip nedeniyle endoskopik yaklaşımla tedavi edilen olgular değerlendirildi.Hastalar ve Yöntemler: Çalışmaya koanal polip nedeniyle endoskopik yaklaşımla ameliyat edilen 12 hasta alındı. Hastalar ameliyat öncesinde endoskopik nazal ve nazofarengeal muayene, paranazal sinüs bilgisayarlı tomografisi ile değerlendirildi; kanda total IgE ve spesifik IgE düzeylerine bakıldı ve deri testi yapıldı. Yedi olguda %58 antroakoanal polip, iki olguda %17 etmokoanal polip, iki olguda sfenokoanal polip, bir olguda %8 konkakoanal polip vardı. Etmokoanal polipli olgularda anterior ethmoidektomi uygulandı. Sfenokoanal polipli olgularda intranazal polipektomi yapıldı. Endoskopik olarak polipin köken aldığı mukoza tam belirlenemeyen antroakoanal polipli iki olguda transkanin sinoskopi yapıldı. Bütün olgularda polipin köken aldığı mukoza temizlendi. Kontrol incelemeleri birinci ve altıncı aylarda ve birinci yılda yapıldı. Bulgular: Hastalarda en sık rastlanan semptomlar burun tıkanıklığı %70 ve burun akıntısı %52 idi. Alerji testlerinde antroakoanal polipli iki olguda alerji saptandı. Komplikasyon olarak iki olguda hafif kanama görüldü. Bir yıl izlem sonunda hiçbir olguda nüks saptanmadı. Sonuç: Koanal polipli olgularda endoskopik yaklaşım tüm yaş gruplarında uygulanabilir ve morbidite oranı düşük bir tedavi yöntemidir

Keywords

Endoskopi, burun tıkanıklığı/etyoloji, nazal polip/radyografi/cerrahi

References

• Lopatin A, Bykova V, Piskunov G. Choanal polyps: one entity, one surgical approach? Rhinology 1997;35:79-83.
• Lessa MM, Voegels RL, Padua F, Wiikmann C, Romano FR, Butugan O. Sphenochoanal polyp: diagnose and treatment. Rhinology 2002;40:215-6.
• Skladzien J, Litwin JA, Nowogrodzka-Zagorska M, Wierzchowski W. Morphological and clinical char- acteristics of antrochoanal polyps: comparison with chronic inflammation-associated polyps of the maxil- lary sinus. Auris Nasus Larynx 2001;28:137-41.
• Chen JM, Schloss MD, Azouz ME. Antro-choanal polyp: a 10-year retrospective study in the pedi- atric population with a review of the literature. J Otolaryngol 1989;18:168-72.
• Schramm VL Jr, Effron MZ. Nasal polyps in children. Laryngoscope 1980;90:1488-95.
• Heck WE, Hallberg OE, Williams HL. Antrochoanal polyp. AMA Arch Otolaryngol 1950;52:538-48.
• Pruna X, Ibanez JM, Serres X, Garriga V, Barber I, Vera J. Antrochoanal polyps in children: CT findings and differential diagnosis. Eur Radiol 2000;10:849-51.
• Cook PR, Davis WE, McDonald R, McKinsey JP. Antrochoanal polyposis: a review of 33 cases. Ear Nose Throat J 1993;72:401-2, 404-10.
• Jang YJ, Rhee CK, Oh CH, Ryoo HG, Kim HG, Ha M. Arachidonic acid metabolites in antrochoanal polyp and nasal polyp associated with chronic paranasal sinusitis. Acta Otolaryngol 2000;120:531-4.
• Ileri F, Koybasioglu A, Uslu S. Clinical presentation of a sphenochoanal polyp. Eur Arch Otorhinolaryngol 1998;255:138-9.
• Myatt HM, Cabrera M. Bilateral antrochonanal polyps in a child: a case report. J Laryngol Otol 1996;110:272-4.
• Sunagawa M, Kinjoh K, Nakamura M, Kosugi T. Urokinase-type plasminogen activator and plasmi- nogen activator inhibitor antigen in tissue extracts of paranasal sinus mucous membranes affected by chronic sinusitis and antrochoanal polyps. Eur Arch Otorhinolaryngol 1999;256:237-41.
• Ozcan C, Unal M, Görür K, Pata YS. A review of antro- choanal polyps in 14 cases. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2002;9:188-92.
• Aktas D, Yetiser S, Gerek M, Kurnaz A, Can C, Kahramanyol M. Antrochoanal polyps: analysis of 16 cases. Rhinology 1998;36:81-5.
• Min YG, Chung JW, Shin JS, Chi JG. Histologic structure of antrochoanal polyps. Acta Otolaryngol 1995;115:543-7.
• Crampette L, Mondain M, Rombaux P. Sphenochoanal polyp in children. Diagnosis and treatment. Rhinology 1995;33:43-5.
• Berg O, Carenfelt C, Silfverswärd C, Sobin A. Origin of the choanal polyp. Arch Otolaryngol Head Neck Surg 1988;114:1270-1.
• Tosun F, Yetiser S, Akcam T, Ozkaptan Y. Sphenochoanal polyp: endoscopic surgery. Int J Pediatr Otorhinolaryngol 2001;58:87-90.
• el-Guindy A, Mansour MH. The role of transca- nine surgery in antrochoanal polyps. J Laryngol Otol 1994;108:1055-7.
• Kamel R. Endoscopic transnasal surgery in antrochoa- nal polyp. Arch Otolaryngol Head Neck Surg 1990; 116:841-3.
• Keleş N, Ilıcalı ÖC, Güldiken Y, Değer K. Çocuk yaş grubunda endoskopik sinüs cerrahisi. Kulak Burun Boğaz İhtisas Dergisi 2000;7:18-22.
• Başak S, Karaman CZ, Akdilli A, Metin KK. Surgical approaches to antrochoanal polyps in children. Int J Pediatr Otorhinolaryngol 1998;46:197-205.
• Sato K, Nakashima T. Endoscopic sinus surgery for chronic sinusitis with antrochoanal polyp. Laryngoscope 2000;110:1581-3.