Choanal polyp originating from the nasal septum: a case report

Almost all nasal polyps originate from the mucosa of the lateral walls of the nasal cavity or from the paranasal sinuses. A choanal polyp is the intranasal portion of a cyst that has arisen from the wall of the maxillary sinus near the ostium. Medially based polyps, such as those that arise from the nasal septum, are rare. The literature cites a wide range of incidence rates for polyps originating from this structure, but choanal extension of this type of polyp is extremely unusual. This report describes a polyp that arose from the superior aspect of the posterior nasal septum and extended through the choana into the nasopharynx. The histology of this choanal lesion was typical of nasal polyps, but the site of origin is rare. The ethiopathogenesis of nasal polyps with its common location remains controversial so it is difficult to speculate what mechanism triggered the development of this lesion on the nasal septum. Some form of local inflammation may have induced choanal polyp formation at this atypical site.     

Choanal polyp originating from the middle turbinate

Choanal polyps usually originate from the maxillary sinus. Unusual origins such as the sphenoid sinus, ethmoid sinus, nasal septum and hard and soft palate have been reported in the literature. Herein, we report a rare case of choanal polyp originating from the middle turbinate that was removed by an endoscopic surgery technique. The computed tomographic findings are described and the literature is reviewed.     

Choanal polyp originated from the inferior nasal concha

Almost all choanal polyps originate from the maxillary sinus and a choanal polyp (CP) originating from the inferior nasal concha (INC) is a rare entity. It presents in a similar manner to the more common antrochoanal polyp and may be confused on anterior rhinoscopy. In this report, an unusual case of a CP taking origin from the INC that was removed by endoscopic endonasal surgery in a young man is presented. No intraoperative or postoperative complication occured, and the symptoms immediately resolved after the operation. Although very rare, CPs arising from the INC should be kept in mind in the differential diagnosis of a solitary nasal polyp.     

Sphenochoanal polyp with heterotopic glial tissue

An isolated polyp arising from the sphenoid sinus is rare. Due to the presence of important structures adjacent to the sphenoid sinus, a proper pre-operative radiological and nasal endoscopic evaluation is mandatory, along with a neurological and ophthalmological assessment. We report the case of a 23-year-old man with a sphenochoanal polyp with heterotopic glial tissue in the stroma. A Medline search did not reveal any previously reported cases of glial tissue in the sphenoid sinus presenting as a sphenochoanal polyp.     

Endoscopic sinus surgery in chronic rhinosinusitis and nasal polyposis: a comparative study

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12?months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1?year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1?year follow up in the nasal polyp group.     

Two cases of paranasal sinusitis with choanal polyp in children]

Patients with choanal polyp often suffer from maxillary sinusitis of the same side. Hence, Caldwell-Luc operation in addition to polypectomy has been recommended for the treatment of choanal polyp. Choanal polyp occurs more frequently in children with nasal polyp(s) than in adults with nasal polyp(s). For this reason, it is preferable to perform surgery so as to preserve the maxillary sinus as much as possible. The authors surgically treated two children with choanal polyp. A 12-year-old girl had a choanal polyp arising from the posterior portion of the middle turbinate and received an osteoplastic maxillary operation and functional endoscopic sinus surgery (FESS). The other, a 13-year-old girl, with an antro-choanal polyp underwent FESS only. One year after surgery, both patients showed no recurrence of polyp and had recovered an aerated maxillary sinus cavity covered with normal mucous membrane. Based on the experiences of these two cases, FESS appears to be very helpful in treating children with choanal polyp and paranasal sinusitis.     

Sphenochoanal polyp - a rare diagnosis in nasal obstruction

One of the most common nasal pathologies to present to an otolaryngologist is polyposis. Two well-recognized forms occur, the common antrochoanal polyp and the rare sphenochoanal polyp. Differentiation between the two is necessary for proper management by endoscopic sinus surgery.     

Evaluation of clinical features of antrochoanal polyps

Current knowledge on the prevalence and clinical features of antrochoanal polyps (ACPs), benign lesions arising in the maxillary sinus and extending into the choana, is very limited in Japan. We prospectively evaluated prevalence and clinical features in 15 subjects with ACPs from among 728 undergoing endoscopic endonasal sinus surgery between April 2007 and March 2008, and prospectively enrolled in this study. The 15 subjects, who accounted for 2.1% of the total, had nasal obstruction, rhinorrhea, and postnasal drip. Symptoms significantly reduced postoperatively. Maxillary-sinus-origin ACP distribution was 40% from the maxillary sinus floor to the posterior wall, 26.7% from maxillary sinus floor, and 20% from the maxillary sinus floor to the internal wall. Postoperative recurrence was 13.3%. Endoscopic endonasal sinus surgery for ACPs was most effective for polyp is originating in the maxillary sinus determined carefully and excised as completely as possible, followed by appropriate postoperative treatment.     

出血坏死性鼻息肉内镜治疗及临床分析

目的探讨鼻内镜手术治疗出血坏死性鼻息肉的疗效,并分析其临床特点。方法29例患者采用鼻内镜下手术治疗,并对术中所见结合CT特征及临床表现进行分析。结果术后6个月疗效评定,29例患者均治愈,内镜及CT检查显示患侧术后中鼻道及上颌窦口宽敞;筛窦、上颌窦腔黏膜基本恢复正常;鼻塞、头痛、血涕等症状均消失。结论鼻内镜手术是治疗出血坏死性鼻息肉的有效方法。     

Simultaneous antrochoanal and sphenochoanal polyps: a rare clinical entity

Choanal polyps almost always appear as solitary growths and most commonly arise from the maxillary sinus. Sphenochoanal and ethmoidochoanal polyps are extremely rare. Co-existence of more than one choanal polyp is even more infrequent. We present a patient with an antrochoanal and an accompanying sphenochoanal polyp for the first time in the literature. We discuss the clinical presentation, pathogenesis and surgical management of this rare clinical entity.     

鼻腔恶性黑色素瘤12例报告

报告鼻腔鼻窦恶性黑色素瘤１２例，该病好发于鼻腔外侧壁和鼻中隔；应与鼻腔癌、血管瘤、鼻息肉相鉴别；广泛彻底切除为本病的主要治疗方法。并对本病的病理组织学改变，临床表现、治疗方法及预后进行讨论。     

Sphenochoanal polyp: endoscopic surgery

Sphenochoanal polyp is a rare entity originating from sphenoid sinus. It may be confused with antrochoanal polyp on anterior rhinoscopy because of its similar appearance. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. Destructive external approaches to gain access to the sphenoid sinus are also not advisable in children for a benign disease. We present two cases of sphenochoanal polyps in two children that were operated by endonasal endoscopic approach. They were free of symptoms after surgery. No complications and recurrences were observed at 28 and 18 months of follow-up periods respectively.     

Cholesterol granuloma of the maxillary sinus presenting as sinonasal polyp

Cholesterol granuloma is usually found in chronic middle ear diseases. However, it rarely occurs in the sinonasal regions and only a few case reports can be found in the literature. The etiology of sinonasal cholesterol granuloma is not yet known, and the clinical manifestations are nonspecific. Most patients presented with nasal discharge. Our patient is the only reported case presenting with nasal obstruction and facial pain. Here we present a patient with cholesterol granuloma of the maxillary sinus with a nasal polyp, whose clinical, imaging, and histological characteristics were unique. The tumor was excised via the transnasal endoscopic sinus approach without recurrence after 3 years of follow-up.     

Evaluation and treatment of antrochoanal polyps

OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through a sinus ostium, and extends into the choana. The common presentation of ACP is unilateral nasal obstruction. The radiographic findings and differential diagnosis of ACPs are discussed by comparing them with data in the literature. METHOD: This study included 19 (14 male, 5 female; median age 24.5 years, range 8-75 years) surgically treated patients with ACPs diagnosed by clinical examination, nasal endoscopy, and computed tomography. RESULTS: Nasal obstruction was found in all cases. Endoscopic sinus surgery was preferred for removal of the nasal part of ACPs in 13 cases. Only in one case, polypectomy combined with Caldwell-Luc operation and septoplasty was performed. The observed complications were as follows: minor hemorrhage in three cases, mild cheek swelling with pain in two patients, and infraorbital hypoesthesia in one case. Histopathologic examination of ACPs revealed loose mucoid stroma and mucous glands, which were covered by respiratory epithelium. CONCLUSION: Endoscopic sinus surgery may be indicated in patients with ACPs because the function and capacity of the maxillary antrum are preserved. The greater portion of the antral part of polyp can be removed while leaving the healthy antral mucosa intact.     

Sphenochoanal polyp presenting with concomitant nasal polyps

A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.     

鼻腔鼻窦恶性肿瘤中BRMS1基因蛋白表达的研究

目的:以鼻腔鼻窦恶性肿瘤为研究对象,探讨肿瘤转移抑制基因BRMS1在其发生、发展和转移中的作用及临床意义。方法:采用免疫组织化学SP法分别检测53例鼻腔鼻窦恶性肿瘤组织、24例鼻息肉组织及10例正常组织中BRMS1基因蛋白的表达,分析在不同临床病理指标下BRMS1蛋白表达的情况。结果:BRMS1蛋白在正常组织中的阳性表达率(90.0%)及息肉组织中的阳性表达率(79.2%)均显著高于癌组织中的阳性表达率(39.6%),差异均有统计学意义(均P<0.01)。癌组织中BRMS1蛋白阳性表达率与临床分期和淋巴结转移有关,与病理分级无关。结论:鼻腔鼻窦恶性肿瘤的发生、发展和转移与BRMS1基因的失活密切相关。     

Sphenochoanal polyp—Surgical review

A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus and protrudes through the choana into the nasopharynx. It can occur at any age but is especially common in adolescents and young adults. We present a case of a sphenochoanal polyp in a seven-year-old girl who presented with bilateral nasal obstruction and an altered voice. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can only be differentiated on cross-sectional imaging (computed tomography and/or magnetic resonance imaging). Endoscopic sinus surgery allows for complete removal and minimizes the risk of recurrence.     

后鼻孔息肉的临床类型和诊断及鼻内镜手术

目的探讨后鼻孔息肉的临床类型、诊断及鼻内镜手术的方法和效果。方法总结1998年1月至2005年12月收治的34例后鼻孔息肉患者的临床资料，分析其发病方式、来源、临床表现、与鼻窦的关系以及鼻内镜手术技巧和疗效。结果①18例发病源于鼻窦囊肿或息肉，其中上颌窦17例，后筛窦1例；②5例发病分别源于鼻囟门或蝶筛隐窝、蝶窦口黏膜，同侧上颌窦或蝶窦积脓或黏膜水肿；③11例发病分别源于中鼻甲、钩突、嗅沟鼻中隔和筛泡前壁黏膜，邻近的鼻窦正常；④全部病例均行鼻内镜手术切除后鼻孔息肉及相应鼻窦开放，术后无复发。结论①建议诊断后鼻孔息肉应分为窦内型、鼻窦阻塞型和单纯型三种临床类型，遵循以临床类型为依据的手术原则，选择合理的术式和范围；②鼻内镜和鼻一鼻窦CT检查可以在术前明确后鼻孔息肉的诊断和临床类型；③鼻内镜手术治疗后鼻孔息肉准确、微创，彻底切除息肉蒂基部，防止复发。     

Malignant mucosal melanoma in the olfactory cleft of a 10-year-old child

Mucosal malignant melanoma is a rare but aggressive neoplasm with high rates of recurrence and death. It is known that two-thirds of mucosal melanoma cases arise in the nasal cavity and paranasal sinuses in adults. However, there have been few studies until now on children with mucosal malignant melanoma and the related treatment. We report on a 10-year-old girl with mucosal malignant melanoma presented as a nasal polyp, which was removed via endoscopic sinus surgery and adjuvant chemotherapy without recurrence.     

鼻内镜手术治疗出血坏死性鼻息肉疗效探讨

目的 探讨鼻内镜手术治疗鼻及鼻窦出血坏死性息肉的可行性及疗效。方法 回顾性分析2002年1月至2010年1月治疗23例鼻及鼻窦出血坏死性息肉的临床资料。病理诊断明确,术前行鼻内镜检查、鼻窦CT及MRI,全身或局部麻醉鼻内镜下行肿物切除术,尤其是辨清其基底及起源地,并完整彻底切除鼻及鼻窦病变组织,是有效防止复发的关键。结果 经鼻内镜手术治愈22例(95.7%),有效1例(4.3%),术中出血少,22例随访2～6年未见复发,1例1年后复发,经鼻内镜联合柯-陆径路再次手术,术后随访2年未见复发。结论 鼻内镜手术治疗鼻及鼻窦出血坏死性息肉,创伤小、出血少、复发率低,彻底切除及术后随访至关重要,是一种简便、安全、有效的首选治疗方法。