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| CASE REPORT |
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| Year : 1991 | Volume
: 37
| Issue : 2 | Page : 123-4 |
Expansion of the maxillary antrum by an antro-choanal polypus (a case report).
Raut VV, Bhattacharya AK
Seth A.J.B. Municipal E.N.T. Hospital, Fort, Bombay.
Correspondence Address:
Seth A.J.B. Municipal E.N.T. Hospital, Fort, Bombay.
How to cite this article:
Raut V V, Bhattacharya A K. Expansion of the maxillary antrum by an antro-choanal polypus (a case report). J Postgrad Med 1991;37:123 |
Antro-choanal polypus seen in routine otolaryngological practice usually conforms to its triradiate nature with a small antral origin, a nasal and a choanal portion. A case of expansion of the maxillary antrum by an antrochoanal polypus is presented for its rarity.
A 26-year-old male presented with a right-sided facial swelling, nasal obstruction, rhinorrhoea, anosmia, headache, hyponasal voice and dysphagia. The patient was apparently alright a year back when he first noticed a gradually increasing right sided nasal obstruction and foul smelling nasal discharge which persisted inspite of antibiotic therapy. Six months later the patient had difficulty in swallowing and noticed an increasing right sided facial swelling. There was no history of epistaxis, palatal swelling, falling of teeth, diplopia or diminished vision.
On examination there was a diffuse swelling of the right side of the face (See [Figure - 1]). On palpation a bony swelling corresponding to the contour of the antero-lateral wall of the antrum was confirmed with no evidence of bone erosion or loss of continuity. On anterior rhinoscopy a single polyp was seen in the right nostril, which was insensitive to touch, surrounded by mucopurulent discharge, arising from the region of the rniddle meatus and extending posteriorly from the choanae into the nasopharynx, which was confirmed by posterior rhinoscopy.
On oropharyngeal examination the soft palate was found to be bulging forwards. There were no other significant positive findings. X-rays of the paranasal sinuses, Water's view (See [Figure - 2]) revealed haziness in the right maxillary sinus, opacity in the right nostril and an increase in the maxillo-coronoid distance. Routine investigations carried out in view of anaesthetic fitness were found to be normal. The patient was treated pre-operatively with a course of antibiotics, antihistaminics and nasal decongestants.
A Caldwell-Luc approach under general anaesthesia was used to remove the antro-choanal polyp. During surgery after elevation of the periosteum, the region of the canine fossa was found to be bulging, bluish white in appearance with a thin anterior antral wall which could be easily chiselled out. On opening the antrum, the polyp bulged out thus indicating the amount of pressure it was exerting on the walls of the maxillary antrum. The polyp was removed in its entirely taking care to remove the diseased antral mucosa. An intranasal antrostomy was done and an antral and nasal pack was kept which was removed after 48 hours. Immediate post-operative recovery was uneventful; however, the antral swelling persisted even after two months.
Histopathology revealed features of an antro-choanal polyp with areas of calcification.
On reviewing the literature we found that the causes of non-malignant expansion of the maxillary sinus are mucocoele, papilloma, chronic maxillary sinusitis, simple chronic hyperplasia of the maxilla (Westmacott) and fibrous dysplasia. Cases of extra-pharyngeal extension of nasopharyngeal angiofibroma causing maxillary expansion are well documented2.
The first case of an antro choanal polypus causing expansion of the maxillary antrum was reported as early as 19661. The rarity of this condition is evident from the fact that this is the second case being reported since 1966.
The causative factor in this expansion is perhaps due to the long-standing duration of a year between the onset of symptoms and the treatment received. This can be histologically corelated from the fact that areas of calcification were seen.
We thank the Dean, BYL Nair Hospital, Mumbai for permitting us to present the hospital data.
| 1. |
Hiranandam LH, Melgiri RD. Expansion of antrum by an antro-choanal polypus. J Laryngol & Otol 1966; 80: 63-65.  |
| 2. | Pickard BM. The complications of sinusitis. In: “Scott Browns Otolaryngology”. Vol. 4. AG Kerr, editor. 5th Edition. London: Butterworth and Co; 1987, pp 203-211.
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