Current Surgical Approaches in Antrochoanal Polyp Treatment
Prof. Dr. Gediz Murat Serin – Ear, Nose and Throat Specialist
Introduction
An antrochoanal polyp is a benign mass that develops from the maxillary (cheek) sinus mucosa, extends into the nasal cavity and from there to the nasopharynx (choana). It is usually unilateral and is more common in children and young adults.
Patients mostly present with complaints such as nasal congestion, postnasal drip, snoring, and feeling of fullness in the back of the nose.
Although it may seem like a simple polyp, the main determinant in antrochoanal polyp treatment is the surgical access route. How the surgeon accesses which part of the sinus directly affects the success of the operation and the risk of recurrence.
How Does an Antrochoanal Polyp Form?
Antrochoanal polyp usually occurs as a result of impaired drainage of the maxillary sinus and consequent chronic inflammation (sinusitis).
When the natural opening (ostium) of the sinus narrows or becomes blocked, edema and negative pressure develop in the mucosa inside. This leads to the mucosa protruding outward through the ostium, that is, polyp formation.
Over time, this tissue progresses into the nose and as far as the nasopharynx.
Factors facilitating the process:
Basic Principle of Treatment: Find the Root, Clean Completely
The most critical point in antrochoanal polyp treatment is to remove not only the part inside the nose, but also the root part inside the maxillary sinus completely.
Because the actual source of the polyp is inside the sinus. If the root is left, the disease recurs after a while.
Therefore, choosing the appropriate surgical approach through which the surgeon can access all parts of the sinus is very important.
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Endoscopic Endonasal Approach (FESS)
Today, it is the gold standard method in antrochoanal polyp surgery.
The natural ostium is widened through the nose with the help of an endoscope, the inside of the sinus is completely visualized, and the area where the polyp is rooted is cleaned.
Advantages:
- No skin incision required, leaves no scar.
- Preserves natural anatomy.
- Recovery is fast and comfortable.
- Cosmetic results are excellent.
When performed correctly, the recurrence rate is around 5–10%.
In addition, this method also allows these problems to be resolved in the same session in patients with accompanying sinusitis or nasal congestion. Thus, both the patient’s breathing quality and sinus health are corrected at the same time.
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Caldwell-Luc Approach
It is a classical method frequently used before the endoscopic surgery era.
With an incision made from the upper lip mucosa, the anterior wall of the maxillary sinus is opened and the polyp is cleaned directly.
Advantage:
- Evaluates the inside of the sinus with a wide view, clarifies the location of the root.
Disadvantages:
- Risk of alveolar wall damage due to working close to tooth roots,
- Infraorbital nerve paresthesia,
- Complications such as facial edema and postoperative scar formation.
Therefore, today the Caldwell-Luc approach is generally preferred in revision cases or in posterior-inferior roots that cannot be reached endoscopically.
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Prelacrimal Recess Approach
It is the most modern and physiological method for accessing the lower and anterior parts of the maxillary sinus, which has come to the forefront in recent years.
In this technique, by entering from the front of the lacrimal canal (tear duct), the entire inner surface of the sinus can be viewed endoscopically.
Advantages:
- Provides atraumatic access to all parts of the sinus.
- No facial incision.
- Lacrimal canal is preserved.
- Risk of recurrence is quite low.
Therefore, especially in recurrent antrochoanal polyp cases, the prelacrimal approach is a more physiological and safer alternative compared to Caldwell-Luc.
How is the Surgical Approach Selected?
The most appropriate surgical method is different for each patient:
- First case → Endoscopic endonasal approach is often sufficient.
- Recurrent or deeply located polyp → Prelacrimal or if necessary Caldwell-Luc can be added.
Surgical selection is determined according to the patient’s age, sinus anatomy, location of the polyp, and accompanying sinusitis/nasal congestion status.
Does Antrochoanal Polyp Recur?
Yes, it can recur.
However, recurrence is usually related to incomplete cleaning of the root inside the sinus or continuation of chronic inflammation.
With the right technique, when the root is completely removed and sinusitis is controlled, the risk of recurrence is quite low.
In the postoperative period:
- Saline irrigation,
- Allergy control,
- Regular endoscopic examination
play an important role in preventing recurrence.
Conclusion
Antrochoanal polyp is a condition that presents with complaints similar to nasal congestion and sinusitis but requires careful surgical planning.
The most important point for successful treatment is to reach the sinus root and completely clean the mucosal source area.
Today, endoscopic sinus surgery is the gold standard. However, in some complex cases, a combination with the prelacrimal approach or Caldwell-Luc method can provide additional advantages to the surgeon.
With proper patient selection, complete resection, and regular follow-up, the risk of recurrence is minimized, and the patient’s both breathing and quality of life significantly improve.
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