Anatomical Variations Favouring Antrochoanal Polyp Genesis

Area of Science:

• Otolaryngology
• Rhinosinusology
• Medical Imaging

Background:

• Antrochoanal polyps (ACP) are pseudotumors of the nasal cavity with controversial etiopathogenesis.
• An association between sinonasal anatomical variants and ACP development is suspected but not well-defined.
• Understanding these variants is crucial for determining ACP formation mechanisms.

Purpose of the Study:

• To identify specific sinonasal anatomical variations significantly associated with the presence of antrochoanal polyps (ACP).
• To investigate the relationship between anatomical variants and the side of ACP occurrence.
• To explore potential precursor relationships between anatomical variations and ACP.

Main Methods:

• A retrospective, descriptive, and comparative study of 54 patients who underwent surgery for ACP.
• Analysis of 108 nasal cavities (54 with ACP, 54 contralateral controls) using imaging data.
• Comparison of the frequency of anatomical variants between ACP-positive and control groups.

Main Results:

• Septal deviation was the most common variant (72.2%). Concha bullosa (33.3%) was the most frequent middle turbinate variant.
• Significant associations were found between ACP and concha bullosa, middle turbinate hypertrophy, and hyperpneumatized ethmoid bulla (p<0.05).
• ACP occurred more frequently on the side opposite to septal deviation (p=0.016), while other variants favored the ipsilateral side. Maxillary sinus volume was larger in the ACP+ group (p=0.00).

Conclusions:

• Nasal septum deviation promotes contralateral ACP, whereas concha bullosa, middle turbinate hypertrophy, and hyperpneumatized ethmoid bulla favor ipsilateral ACP.
• Systematic reporting of anatomical variations on CT scans and surgical correction of predisposing factors are recommended.
• Close monitoring for recurrence in patients with these variations is advised post-surgery.