Proboscis lateralis with contralateral antrochoanal polyp in an adult: a case report

Proboscis lateralis (PL) is an extremely rare congenital craniofacial anomaly characterized by a tubular nasal appendage. Most cases undergo surgical correction in early childhood, and adult presentations are uncommon. Associations with contralateral sinonasal disease are rarely reported. We present the first surgically managed adult case of PL from Pakistan with a previously unreported coexisting contralateral antrochoanal polyp (ACP).

A 21-year-old male presented with a congenital left-sided nasal appendage and progressive right nasal obstruction. Examination revealed a 3-cm tubular proboscis and a right nasal polyp. MRI confirmed PL without intracranial extension and an 8-cm right ACP extending into the nasopharynx. The patient underwent surgical management consisting of excision with primary closure and functional endoscopic sinus surgery with middle meatal antrostomy. Histopathology confirmed respiratory epithelium in the proboscis and inflammatory ACP. Recovery was uneventful, and at the 6-month follow-up, the patient reported complete symptom resolution, no recurrence, and high satisfaction with the aesthetic result.

This case expands the literature on adult PL management and demonstrates that delayed surgical intervention can achieve excellent outcomes. The coexistence of PL and contralateral ACP suggests compensatory airflow alterations due to ipsilateral hypoplasia and septal deviation. This underscores the importance of comprehensive bilateral sinonasal evaluation in all PL patients. Simple excision without complex reconstruction proved effective in this adult case.

Adult correction of PL is feasible and effective. The novel association with contralateral ACP highlights the need for thorough imaging and tailored surgical planning in patients with this rare anomaly.