Surgical approaches for antrochoanal polyp: a comparative analysis

The aim of this study was to evaluate the clinical and histopathological characteristics of antrochoanal polyps (ACPs) and to perform a comparative analysis of surgical techniques in terms of recurrence.

The clinical, radiological and histopathological features of 42 patients with a diagnosis of ACP who underwent surgery in a period of 6 years (January 2000 - January 2006) were investigated retrospectively. Histopathological examinations were present for all patients and were re-examined for histological analysis.

Endoscopic sinus surgery (ESS) was performed in all patients. Transcanine sinoscopy (TS) and the Caldwell-Luc approach (CL) were used in addition to ESS in 14 and 13 patients respectively. The attachment site was detected in 21 patients (50%) and the most frequent site was found to be the lateral wall in 15 patients (71.4%). There was no relationship between the choice of surgery, the attachment site or accessory ostium, or any sinusitis with ACP. Histological examination showed prominent eosinophilia in 29 patients (69%). The follow-up time was a minimum of 12 months with a mean of 28.9 months. Three recurrences were seen after ESS. However, there was no recurrence after ESS+TS and ESS+CL.

Our study showed that the most important factors affecting the choice of surgical approaches are the preference of the surgeon, the age of the patient and the presence of recurrent disease. Combined approaches with either TS or CL should be considered, particularly when the attachment site of the antral part of ACP is undetected, in order to prevent incomplete excision and recurrences.