Septochoanal polyp: a case report and literature review

The septochoanal polyp is an exceptionally rare variant of a choanal polyp, distinguished by its origin from the nasal septum rather than the paranasal sinuses. To our knowledge, fewer than fifteen cases of true septochoanal polyps have been reported to date.

A 65-year-old male presented with persistent right-sided nasal obstruction and hyponasality despite prior septal surgery. Nasal endoscopy revealed a large anterior septal perforation and a substantial polypoid lesion extending into the nasopharynx. Computed tomography confirmed a homogeneous mass originating from the superior nasal septum, with no sinus involvement. The patient underwent successful, complete endoscopic excision of the lesion, which was delivered transorally because of its size.

This case contributes to the scarce literature on this rare entity. The patient's history of septal surgery and the subsequent perforation support the theory that mechanical stress and turbulent nasal airflow may be significant factors in the pathogenesis of septal-origin polyps. Endoscopic surgery, entailing complete removal of the polyp along with its pedicle and a small mucosal margin, is the definitive treatment, resulting in a low recurrence rate and an excellent prognosis.

The septochoanal polyp, while rare, should be considered in the differential diagnosis of a unilateral choanal mass. A combination of endoscopic examination and computed tomography is essential for precise preoperative localization of its septal origin. Endoscopic surgical excision remains the treatment of choice, offering a definitive cure. This case further highlights the potential role of disrupted nasal aerodynamics in the development of this unusual polyp.