Endoscopic Management of Antrochoanal Polyps

Antrochoanal polyps are benign mucosal outgrowths originating in the maxillary sinus antrum and extending through the ostium into the choana. They predominantly affect children and young adults, presenting most often with unilateral nasal obstruction, rhinorrhoea and, occasionally, snoring or sleep-disordered breathing. Endoscopic management has become the standard of care, seeking complete removal of both the nasal and antral components while preserving healthy mucosa and mucociliary function. Technological advances in endoscopic optics, instrumentation and image guidance have refined approaches ranging from simple endoscopic polypectomy with middle meatal antrostomy to more extensive techniques such as extended middle meatal antrostomy, transnasal prelacrimal recess approaches and adjunctive canine-fossa puncture. These methods aim to visualise and resect the antral attachment completely, thereby minimising recurrence rates, which historically have ranged from 6 % to over 20 %. Contemporary series report recurrence rates below 5 % with extended or combined approaches. Computed tomography remains indispensable for preoperative mapping of polyp origin and for planning the most appropriate access route. In paediatric patients, concomitant adenoid hypertrophy is frequently encountered and may be managed simultaneously to optimise nasal patency and reduce the risk of residual disease. Day-case endoscopic excision has proven safe and effective in both adult and paediatric cohorts, underscoring the global shift towards minimally invasive, outpatient-based practice. Continued research focuses on long-term outcomes, the comparative efficacy of emerging endoscopic corridors and the role of adjunctive therapies in reducing recurrence.

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Endoscopic Management of Antrochoanal Polyps publication trend

The graph below shows the total number of articles in endoscopic management of antrochoanal polyps across all publications each year (not limited to Nature Index journals).

Technical terms

Antrochoanal polyp: A solitary benign lesion arising in the maxillary sinus antrum and extending posteriorly into the choana.

Middle meatal antrostomy (MMA): Endoscopic enlargement of the natural maxillary ostium via the middle nasal meatus.

Extended middle meatal antrostomy: A more radical widening of the medial maxillary wall to enhance access to the antral recess.

Prelacrimal recess approach: An endoscopic corridor anterior to the lacrimal duct that provides direct access to the floor and anterior wall of the maxillary sinus.

Adenoidectomy: Surgical removal of hypertrophic adenoid tissue often performed concurrently to improve nasal airflow and reduce disease recurrence.

References

1. Comparison of conventional and extended middle meatal antrostomy for the treatment of antrochoanal polyps. BMC Surgery (2023).
2. Endoscopic endonasal prelacrimal recess approach for antrochoanal polyp. The Egyptian Journal of Otolaryngology (2019).
3. Adenoid hypertrophy is a common finding in children with antrochoanal polyp. The Egyptian Journal of Otolaryngology (2021).
4. Day case endoscopic excision of an antrochoanal polyp in a paediatric patient. Journal of Surgical Case Reports (2021).