Antrochoanal Polyp Among Children: A Review

Abstract

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Abstract Antrochoanal polyp (ACP) or Killian polyp originates from the inflamed and edematous mucosa of the maxillary sinus. The etiopathogenesis of the ACPs is not clear. It has two components such as antral one which is always cystic and the nasal part is solid. The expanded intramural cyst enlarges to the point that it completely occupies the maxillary sinus, emerging through the natural ostium into the nasal cavity and extending towards the choana. The common clinical presentations are nasal obstruction and nasal discharge. Diagnostic nasal endoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI)are needed for making the diagnosis and the treatment planning. Surgery is indicated for the treatment of ACP. The endoscopic technique consists of an uncinectomy and resection of the polyp and its attachment to the maxillary sinus via a wide middle meatal antrostomy. Endoscopic sinus surgery via middle meatal antrostomy combined with trans-canine sinuscopy ensures the complete removal of the antral part of the ACP in children. The use of a microdebrider through the canine fossa is helpful to resect a broad attachment of the ACP in the maxillary sinus and it may be indicated as complementary to endoscopic sinus surgery. Simple avulsion of the ACP has a high chance of recurrence, whereas the Caldwell Luc procedure is associated with damage to the maxillary and dental growth centers. More research is needed for establishing the exact etiopathology and newer treatment options for ACPs.

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© 2023 D Y Patil Journal of Health Sciences | Published by Wolters Kluwer - Medknow 49
Received: 25-Sep-2022, Revised: 31-Oct-2022, Accepted: 01-Nov-2022,
Published: 23-May-2023
Address for correspondence: Dr. Santosh Kumar Swain,
Department of Otorhinolar yngology and Head and Neck Surgery, IMS
& SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinga Nagar,
Bhubaneswar 751003, Odisha, India.
E-mail: santoshvoltaire@yahoo.co.in
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as
appropriate credit is given and the new creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
How to cite this article: Swain SK. Antrochoanal polyp among
children: Areview. D Y Patil J Health Sci 2023;11:49-54.
Review Article
Antrochoanal Polyp Among Children: A Review
Santosh Kumar Swain
Department of Otorhinolar yngology and Head and Neck Surgery, IMS & SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India
Abstract
Antrochoanal polyp (ACP) or Killian polyp originates from the inflamed and edematous mucosa of the maxillary sinus. The
etiopathogenesis of the ACPs is not clear. It has two components such as antral one which is always cystic and the nasal part is solid.
The expanded intramural cyst enlarges to the point that it completely occupies the maxillary sinus, emerging through the natural
ostium into the nasal cavity and extending towards the choana. The common clinical presentations are nasal obstruction and nasal
discharge. Diagnostic nasal endoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI)are needed for
making the diagnosis and the treatment planning. Surgery is indicated for the treatment of ACP. The endoscopic technique consists of
an uncinectomy and resection of the polyp and its attachment to the maxillary sinus via a wide middle meatal antrostomy. Endoscopic
sinus surgery via middle meatal antrostomy combined with trans-canine sinuscopy ensures the complete removal of the antral part
of the ACP in children. The use of a microdebrider through the canine fossa is helpful to resect a broad attachment of the ACP in
the maxillary sinus and it may be indicated as complementary to endoscopic sinus surgery. Simple avulsion of the ACP has a high
chance of recurrence, whereas the Caldwell Luc procedure is associated with damage to the maxillary and dental growth centers. More
research is needed for establishing the exact etiopathology and newer treatment options for ACPs.
Keywords: Antrochoanal polyp, children, endoscopic sinus surgery, maxillary sinus
IntroductIon
Antrochoanal polyps (ACPs) are benign polypoidal lesions
originating from the mucosal lining of the maxillary
sinus.[1] It is usually found on one side nasal cavity and
is solitary in nature. It comes from the maxillary sinus
to the nasal cavity through the accessory ostium and
extends towards the choana.[1] ACPs usually have two
parts such as cystic, which frequently fills the maxillary
sinus, and the other solid polypoidal part, which extends
into the middle meatus and the nasopharynx.[2] ACP is
usually unilateral, although a few patients with bilateral
ACPs were documented in the medical literature, mainly
among children.[3] The common clinical manifestations
in children with ACPs are nasal obstruction and nasal
discharge.[4] In severe cases, it may manifest with epistaxis,
dyspnea, dysphagia, and weight loss.[4] In children,
juvenile nasopharyngeal angiofibroma, encephalocele,
nasopharyngeal malignancies, grossly enlarged adenoid
hypertrophy, turbinate hypertrophy, and nasal polyposis
are considered the differential diagnosis of ACP.[5]
Diagnostic nasal endoscopy, CT scan, and MRI are the
main diagnostic techniques for ACPs.[6] The treatment
of ACP in children is surgical and most surgeons prefer
being conservative in the surgery of ACP in children.
This review article aims to discuss the epidemiology,
etiopathology, clinical presentations, investigations, and
treatment of ACPs among children.
Methods of LIterature search
Multiple systematic methods were used to find current
research publications on the antrochoanal polyp among
children and its epidemiology, etiopathology, clinical
manifestations, and management. We started by searching
the Scopus, PubMed, Medline, and Google Scholar
Access this article online
Quick Response Code:
Website:
www.dypatiljhs.com
DOI:
10.4103/DYPJ.DYPJ_63_22

Swain: Antrochoanal polyp among children
50 50 D Y Patil Journal of Health Sciences ¦ Volume 11 ¦ Issue 1 ¦ January-March 2023
databases online. A search strategy using PRISMA
(Preferred Reporting Items for Systematic Reviews and
Meta-Analysis) guidelines was developed. This search
strategy recognized the abstracts of published articles,
while other research articles were discovered manually
from the citations. Randomized controlled studies,
observational studies, comparative studies, case series,
and case reports were evaluated for eligibility. There were
a total number of articles 88 (27 case reports;23 cases
series; 38original articles) [Figure 1]. This paper focuses
only on the details of ACP among children. This review
article describes the epidemiology, etiopathology, clinical
presentations, investigations, and treatment of ACP among
children. This analysis provides a better understanding
of ACP among children and its clinical profile along
with its management. It will also catalyze further study
of the etiopathogenesis of ACPs among children and
the development of a newer surgical technique for the
management of thispolyp.
hIstory
In 1691, Fredrik Ruysch described two cases of nasal polyps
arising from the maxillary sinus.[7] In 1891,Zuckerkandl
documented a case of a polyp originating from the
maxillary sinus and coming out through a wide
accessory ostium.[8] ACPs were described by Paefyn in
1713.[8] However, Killian is commonly credited with first
documenting this clinical entity in 1906.[9]
epIdeMIoLogy
The incidence and prevalence of ACPs have been poorly
investigated. In the general population, ACPs are found
approximately 4 to 6% of all nasal polyps.[2] ACPs are
most commonly found in children and young adults.[10]
ACPs constitute around 35% of nasal polyps in children
without a clear gender difference.[11]Approximately 48.2%
of cases of ACPs are seen in children.[12] Approximately
40% of the patients with ACPs are in the range of 30 to
65years.[12] Another study showed that ACPs may occur in
any age group.[13] ACPs are more common in males than
females.[13] There is a slight predominance of the ACPs in
the left maxillary sinus among both children and adult
age groups.[14] Another study showed that 33% of all nasal
polyps are ACPs in children.[15]
etIopathoLogy
Although different hypotheses have been described,
the etiopathogenesis for the ACPs is still unclear. The
majority has accepted the “blocked acinus theory”:it is
thought that ACPs arise from the antral cysts development
occurred by acinar mucus gland blockage as a result of
chronic phlogosis (allergic or infectious).[16]Closure of
the osteomeatal complex/middle meatus level decides
an increase in pressure in the maxillary sinus or High
moro antrum forcing the herniation of the polyp into
the nasal cavity via the accessory ostium [Figure 2].[13]
Others documented that lymphatic obstruction, whether
primary(area of higher tissue pressure) or secondary
Figure 1: Flow chart showing methods of literature search Figure 2: Flow chart showing development of the ACP

Swain: Antrochoanal polyp among children
D Y Patil Journal of Health Sciences ¦ Volume 11 ¦ Issue 1 ¦ January-March 2023 51
to chronic sinusitis might play an important role inthe
development of ACPs.[11] Chronic sinusitis and allergy
have been implicated in the development of ACPs. Lee and
Huang documented that 65% of the patients with ACP
had chronic sinusitis.[17] ACPs are inflammatory polyps
originating from the mucosa of the maxillary sinus. It has
two components such as the antral part which is cystic and
the nasal part is a solid one. The cystic component usually
arises from the posterior, inferior, lateral, or medial walls
of the maxillary sinus, and it attaches to the solid part of
the ACP in the nasal cavity.[18] One study showed that the
most common site of origin of ACP is the posterior wall
of the maxillary sinus.[19] The most common etiology of
ACP in children is chronic inflammatory bacterial diseases
and/or cystic fibrosis. Allergy is an uncommon etiology
for the development of ACP.ACPs which could develop
from an expanding intramural cyst in the maxillary sinus
may cause maxillary sinusitis and osteomeatal complex
disease when the polyp expands to impede the maxillary
sinus ostium or hinder the mucociliary function of the
mucosa in the sinus. Chronic maxillary sinusitis, instead of
being the cause of ACPs, could be the result of blockage
of the maxillary sinus ostium by ACPs.[17] Some authors
showed a statistically significant association of ACP with
allergic diseases. Cook et al. reported allergic rhinitis in
approximately 70% of their patients with ACP.[20] Chen
etal. documented that allergic disease plays an important
role in ACP.[16] However, other authors found no association
between allergy with ACP.[21] There is a possible role of the
urokinase type plasminogen activator and inhibitor in the
etiopathogenesis of the ACPs.[22] There is also the role of
arachidonic acid metabolites in the pathogenesis of the
A C P. [23] One recent study showed decreased lipoxygenase
pathway products in the pathogenesis of the ACP.[23]
cLInIcaL ManIfestatIons
ACPs are most commonly found in children and young
adults.[1] Left-sided ACPs are more common than the
right side.[17,24] Astudy showed a male predominance of
ACPs whereas others noted a female preponderance.[24]
The common clinical presentations are often similar
to several other diseases of the paranasal sinuses such
as nasal obstruction, nasal discharge, headache, and
snoring.[25] The most common symptom of the patient
with ACP is nasal obstruction.[25] The nasal obstruction
may be unilateral or bilateral. If the ACP is very large,it
may occupy the whole nasopharynx and block both
choanae resulting in bilateral nasal obstruction.[26] ACPs
are almost always unilateral; there are very few published
cases of bilateral ACPs in the medical literatures.[27] Other
clinical presentations of children with ACPs are sleep
apnea, mouth breathing, post-nasal discharge, epistaxis,
dyspnea, and hyposmia.[28] The nasal discharge is usually
a mucous or mucous-purulent secretion.[29] Patients of
ACPs presenting with epistaxis should be excluded from
angiofibroma in male pediatric age and malignancy in
adult and elderly age groups.[30] Obstructive sleep apnea
is uncommon at an early stage of ACPs among children
in contrast to the adult age group. There are three
explanations for this issue. First, the higher mean age
of pediatric patients has a significantly larger size of the
nasopharynx in comparison to the younger age group
with adenoid enlargement. Secondly, there is incomplete
obstruction of the nose by ACPs. The third explanation is
that ACPs of pediatric age present less often with apnea
than adult age groups.[7] It may obstruct the eustachian
tube opening at the nasopharynx, thus resulting in
secretory otitis media.[18] There may be associated with
epistaxis in the case of infected ACP.[31,32] Anterior
rhinoscopy usually shows ACP as a unilateral polyp.[33]
Sometimes is so large that ACP may be seen behind the
uvula in the oropharyngeal examination.[34]
dIagnosIs
Patients with ACP require a careful history taking,
diagnostic nasal endoscopy, and radiological tests to
confirm the diagnosis. History of nasal obstruction, nasal
discharge, snoring, anosmia and mouth breathing in
children often prompt the clinicians to rule out ACP.[25] The
diagnostic nasal endoscopy and computed tomography
(CT) scan are the gold standard tools for the diagnosis of
ACPs.[10] By using a CT scan, the diagnosis of ACP is made
when a mass fills the maxillary sinus growing through the
accessory or natural ostium into the middle meatus and
choana [Figure 3]. In MRI, it shows T1 hypointense and
T2 enhanced signals in ACPs. If intravenous contrast
with gadolinium is administered during MRI, the
intra-sinusal cystic part of the ACP is only peripherally
enhanced, whereas the nasal and choanal parts show
hypointense images.[34] The ACPs are classified into three
patterns in the CT findings such as Stage I(antronasal
Figure 3: CT scan of the paranasal sinus showing left ACP

Swain: Antrochoanal polyp among children
52 52 D Y Patil Journal of Health Sciences ¦ Volume 11 ¦ Issue 1 ¦ January-March 2023
polyp);stage II(where ACP extends into the nasopharynx
and the ostium of the maxillary sinus is blocked fully
by the neck of the ACP); stage III(ACP extended into
the nasopharynx and the ostium of the maxillary sinus
is blocked partially by the neck of the ACP).[35] The
biopsy and histopathological study are helpful for the
definite diagnosis of the ACPs. Macroscopically, ACP is
composed of a cystic part filling the maxillary sinus and
a solid part coming out via the maxillary ostium into the
middle meatus and extending towards the nasopharynx.
Histologically, there is essentially a difference between
ACP and nasal polyp. The mucosal surface of the ACP
is formed by the respiratory epithelium. The ACP often
contains sparse mucous glands and has a myxoid stroma
with variable densities of inflammatory cells concentrated
near the surface. Sometimes, secondary stromal
alterations may occur such as prominent fibrovascularity,
neovascularization, and thrombosis, which may result in
difficulty in the differential diagnosis.[36] The polyp surface
is covered by respiratory epithelium. From per histological
point of view, nasal polyps can be classified into four
types:(1) edematous, eosinophilic or allergic is the most
common type, formed by edematous connective tissue and
isolated glands, without the development of cysts with a
rich eosinophilic infiltrate and goblet cell hyperplasia;(2)
ductal, formed by glands and cysts;(3) fibrous or fibro-
inflammatory, with a proliferation of fibroblasts and
collagen, and a lymphocyte inflammatory infiltrate; and
(4) polyps with stromal atypia, which are very scared and
differentiated from genuine neoplasms by the lack of the
mitosis.[37]
The differential diagnosis of the ACP includes
different causes of unilateral nasal obstruction and
ipsilateral nasal masses. The differential diagnosis
of ACPs includes juvenile nasopharyngeal fibroma,
olfactory neuroblastoma, meningoencephalocele, or
hemangioma.[38] Inverted papilloma is usually a unilateral
lesion that should be differentiated from the ACP. Other
lesions such as lymphoma, Wegner granulomatosis,
or rhabdomyosarcoma should also be considered for
differential diagnosis.[39,40]
treatMent
The treatment of ACPs in children is essentially surgical.
The treatment of ACP is surgery based, and there are
several access approaches to the polyp. Historically,
surgical treatment has involved two different approaches
such as simple avulsion of the polyp or the Caldwell Luc
procedure. Simple avulsion of the ACP alone carries a
high rate of recurrence.[41] So, the antral portion of the
ACP should be excised completely to avoid recurrence.
There is controversy regarding the route of removal of
the antral part of the ACP. The Caldwell Luc procedure
provides good exposure and ensures complete removal of
the antral part of the ACP.[42] The Caldwell Luc technique
is usually avoided in the pediatric age group because of
the risk of injuring anterior dental roots and maxillary
growth centers. In children, the Caldwell Luc procedure
gives significant risks to the development of teeth and bone
growth centers of the maxilla. There are also other possible
side effects of the Caldwell Luc procedure are cheek
swelling, anesthesia of the cheek and maxillary teeth, and
long recovery time.[43] The types of surgical techniques are
decided by the endoscopic accessibility for the antral part
of the ACPs. Functional endoscopic sinus surgery (FESS)
has been shown to be a safe and effective technique for the
treatment of ACPs. FESS has been widely accepted for
the treatment of ACPs in children.[44] It includes excision
of the polyp(trans-nasally or trans-orally depending on
the size) and treatment of the obstructed osteomeatal
complex. Other external approaches are the Caldwell Luc
procedure, mini-Caldwell Luc, or trans-canine sinuscopy
can be used alone or associated with endoscopic surgery.[45]
FESS consists of endoscopic excision of the nasal part
of the polyp and cystic antral part with attachment to
the wall of the maxillary sinus via the middle meatus.[13]
During performing FESS, the lower part of the uncinate
process is removed and then the maxillary ostium is
widened for exposure of the maxillary sinus. The antral
part of the ACP is excised byan endoscopic approach via
the natural ostium after its adequate widening. However,
in some cases of ACPs, the antral part of the ACPs is
difficult to access endoscopically, so excised through the
opening via the canine fossa. Some prefer a combination
of FESS and the Caldwell Luc approach for the treatment
of ACPs. One study showed that recurrence may be found
in a few cases by only the FESS approach yet not found
recurrence after the combined FESS and Caldwell Luc
or trans-canine sinoscopy approach.[46] Another study
used a mini-Caldwell Luc approach with FESS in their
study patients.[47] They reported minimal recurrence and
a low complication rate, so this technique is helpful to
remove the ACPs completely.[47] Hong etal. recommended
powered instruments during FESS for the effective surgical
outcome and found an improvement rate of 96.4% and no
significant complications when powered instrumentation
was used.[48] Combined endoscopic middle meatal surgery
and trans-canine sinuscopy are helpful for the removal of
the residual tissue of the ACPs from the maxillary antrum.
Lee and Huang performed a trans-nasal endoscopic
approach for ACPs originating from the posterior and
inferior walls of the maxillary sinus and they also used
a combined endoscopic and trans-canine approach for
ACPs originating from the lateral walls of the maxillary
sinus and recurrent cases. They reported the success rate
of the trans-nasal endoscopic approach and combined
endoscopic with the trans-canine approach as 76.9% and
100% respectively.[49] The use of a micro-debrider though
canine fossa is helpful to resect a broad attachment of
the ACP in the maxillary sinus and it may be indicated as
complementary to endoscopic sinus surgery.[49]

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D Y Patil Journal of Health Sciences ¦ Volume 11 ¦ Issue 1 ¦ January-March 2023 53
prognosIs
There is a risk of recurrence postoperatively in the
case of ACPs. Recurrent ACP often occurs depending
on the re-growth of the residual polypoidal tissue in
the maxillary sinus.[3] One study showed a recurrence
rate of 14% in children with ACPs who underwent
only endoscopic sinus surgery.[50] In the same study, the
combined approach was done in some patients, and
the recurrence rate was reduced to 8%.Another study
determined that the recurrence rate was 11.1% in children
who only underwent endoscopic sinus surgery, and the
recurrence rate was 6.9% in adults who had undergone
a combined surgical approach.[12] One study showed that
Mitomycin-C application on the wall of the maxillary sinus
after complete removal of the ACP reduces the chance of
recurrence.[51]
concLusIon
Antrochoanal polyp (ACP) should be considered in the
differential diagnosis for any child presenting with nasal
obstruction and a nasal mass. It requires a careful history,
diagnostic nasal endoscopy, and radiological tests to
confirm the diagnosis of ACP. Endoscopic sinus surgery
with middle meatal antrostomy combined with trans-
canine sinoscopy helps the complete removal of the antral
part of the ACP. Although more effective and safe surgical
techniques have been developed, recurrences of ACPs in
children are stillhigh.
Financial support and sponsorship
Not applicable.
Conflicts of interest
There are no conflicts of interest.
references
1. Aydın S, Taskin U, Orhan I, Altas B, Oktay MF, Toksöz M,
et al. The analysis of the maxillary sinus volumes and the nasal
septal deviation in patients with antrochoanal polyps. Eur Arch
Otorhinolaryngol 2015;272:3347-52.
2. GalluzziF, PignataroL, Maddalone M, GaravelloW. Recurrences
of surgery for antrochoanal polyps in children: Asystematic review.
Int J Pediatr Otorhinolaryngol 2018;106:26-30.
3. El-Sharkawy AA. Endoscopic management of paediatric
antrochoanal polyp: Our experience. Acta Otorhinolaryngol Ital
2013;33:107-11.
4. Salib RJ, Sadek SA, Dutt SN, Pearman K. Antrochoanal polyp
presenting with obstructive sleep apnoea and cachexia. Int J Pediatr
Otorhinolaryngol 2000;54:163-6.
5. Swain SK, Samal R, Sahu MC. Isolated nasal septal neuroglial
heterotopia–A case report. Pediatria Polska 2015;90:323-7.
6. SwainSK, DattatreyaK. A giant nasal septal schwannoma-A case
report. Int J Cur Res Rev 2021;13:70-2.
7. Brausewetter F, Hecht M, Pirsig W. Antrochoanal polyp and
obstructive sleep apnoea in children. J Laryngol Otol 2004;118:
453-8.
8. Sayed RH, Abu-Dief EE. Does antrochoanal polyp present with
epistaxis? J Laryngol Otol 2010;124:505-9.
9. KillianG. The origin of choanal polyp. Lancet 1906;2:81.
10. Choudhury N, Hariri A, Saleh H. Endoscopic management of
antrochoanal polyps: A single Uk centre’s experience. Eur Arch
Otorhinolaryngol 2015;272:2305-11.
11. MostafaHS, FawzyTO, JabriWR, AyadE. Lymphatic obstruction:
A novel etiologic factor in the formation of antrochoanal polyps.
Ann Otol Rhinol Laryngol 2014;123:381-6.
12. LeeDH, Yoon TM, Lee JK, LimSC. Difference of antrochoanal
polyp between children and adults. Int J Pediatr Otorhinolaryngol
2016;84:143-6.
13. FrosiniP, PicarellaG, DeCamporaE. Antrochoanal polyp: Analysis
of 200 cases. Acta Otorhinolaryngol Ital 2009;29:21-6.
14. DaiLB, ZhouSH, RuanLX, Zheng ZJ. Correlation of computed
tomography with pathological features in angiomatous nasal polyps.
Plos One 2012;7:e53306.
15. SchrammVL Jr, EffronMZ. Nasal polyps in children. Laryngoscope
1980;90:1488-95.
16. ChenJM, SchlossMD, AzouzME. Antro-choanal polyp: A10-year
retrospective study in the pediatric population with a review of the
literature. J Otolaryngol 1989;18:168-72.
17. Lee TJ, Huang SF. Endoscopic sinus surgery for antrochoanal
polyps in children. Otolaryngol Head Neck Surg 2006;135:688-92.
18. SwainSK, SahuMC. An unusual giant isolated mucosal malignant
melanoma of nasal cavity: Acase report. Egypt J Ear Nose Throat
Allied Sci 2017;18:151-3.
19. ZhengH, TangL, SongB, YangX, ChuP, HanS, etal. Inflammatory
patterns of antrochoanal polyps in the pediatric age group. Allergy
Asthma Clin Immunol 2019;15:39.
20. CookPR, Davis WE, McDonald R, McKinsey JP. Antrochoanal
polyposis: Areview of 33 cases. Ear Nose Throat J 1993;72:401-2,
404-10.
21. AktaşD, YetişerS, GerekM, KurnazA, CanC, KahramanyolM.
Antrochoanal polyps: Analysis of 16 cases. Rhinology 1998;36:81-5.
22. Sunagawa M, Kinjoh K, Nakamura M, Kosugi T. Urokinase-
type plasminogen activator and plasminogen activator inhibitor
antigen in tissue extracts of paranasal sinus mucous membranes
affected by chronic sinusitis and antrochoanal polyps. Eur Arch
Otorhinolaryngol 1999;256:237-41.
23. JangYJ, RheeCK, OhCH, RyooHG, KimHG, HaM. Arachidonic
acid metabolites in antrochoanal polyp and nasal polyp associated
with chronic paranasal sinusitis. Acta Otolaryngol 2000;120:531-4.
24. Chagarlamudi K, O’Brien WT, Towbin RB, Towbin AJ.
Antrochoanal polyp. Appl Radiol 2019;48:38-40.
25. YamanH, YilmazS, KaraliE, GucluE, OzturkO. Evaluation and
management of antrochoanal polyps. Clin Exp Otorhinolaryngol
2010;3:110-4.
26. SwainSK. Sphenoid sinus mucocele: Areview. Int J Otorhinolaryngol
Head Neck Surg 2022;8:431-6.
27. JmeianS. Bilateral Antrochoanal polyps in a child: An extremely
rare case. JRMS 2006;13:57-8.
28. FreitasMR, GiestaRP, PinheiroSD, SilvaVC. Antrochoanal polyp:
Areview of sixteen cases. Braz J Otorhinolaryngol 2006;72:831-5.
29. SwainSK. Middle turbinate concha bullosa and its relationship with
chronic sinusitis: Areview. Int J Otorhinolaryngol Head Neck Surg
2021;7:1062-67.
30. Swain SK, Debta P, Samal S, MohantyJN, Debta FM, Dani A.
Endoscopic treatment of sinonasal ossifying fibroma: Acase report.
Indian J Public Health 2019;10:1697-700.
31. Robson AK, Barker CS, Whittet HB. Epistaxis as an unusual
presentation of an antrochoanal polyp. J LaryngolOtol 1990;104:643-4.
32. SwainSK, SahuMC, BaisakhMR. Nasal myiasis in clinical practice.
Apollo Med 2018;15:128-31.
33. Swain SK, Samal S, Mohanty JN. Cartilaginous choristoma at
nasopharynx. J Anat Soc India 2020;69:113-5.
34. SwainSK, Das A, Samal R, Behera IC, Sahu MC. An unusually
giant frontoethmoidal mucopyocele in a child–A case report.
Pediatria Polska 2015;90:511-4.
35. VuysereS, Her mansR, MarchalG. Sinochoanal polyp andits variant,
the angiomatous polyp: MRI findings. EurRadio 2001;11:55-8.

Swain: Antrochoanal polyp among children
54 54 D Y Patil Journal of Health Sciences ¦ Volume 11 ¦ Issue 1 ¦ January-March 2023
36. ChungSK, ChangBC, DhongHJ. Surgical, radiologic, and histologic
findings of the antrochoanal polyp. Am J Rhinol 2002;16:71-6.
37. WoolleyAL, ClaryRA, LuskRP. Antrochoanal polyps in children.
Am J Otolaryngol 1996;17:368-73.
38. HellquistHB. Nasal polyps update. Histopathology. Allergy Asthma
Proc 1996;17:237-42.
39. Swain SK, Behera IC, Sahu MC. Primary sinonasal tuberculosis:
Our experiences in a tertiary care hospital of eastern India. Egypt J
Ear Nose Throat Allied Sci 2017;18:237-40.
40. GraingerAJ, Zammit-MaempelI. Antrochoanal polyps inchildren.
EurRadiol 2001;11:347.
41. Jena A, Swain SK. A study of anatomical variations in chronic
rhinosinusitis with special reference to deviated nasal septum. IJAR
2019;5:15-7.
42. Castellanos ZM, Harris YT, Petell GL. Antrochoanal polyp in
pediatric age. Apurpose of a clinical case. J Otolaryngol ENT Res
2022;14:70-2.
43. Bhama LK, Soni NK. Angiomatous antrochoanal polyp causing
epistaxis and bone destruction. Clin Rhinol An Int J 2018;11:
25-8.
44. SwainSK, Behera IC, Mohanty S, SahuMC. Rhinogenic contact
point headache–Frequently missed clinical entity. Apollo Med
2016;13:169-73.
45. VlemingM, deVriesN. Endoscopic sinus surgery for antrochoanal
polyps. Rhinology 1991;29:77-8.
46. Al-Mazrou KA, Bukhari M, Al-Fayez AI. Characteristics of
antrochoanal polyps in the pediatric age group. Ann Thorac Med
2009;4:133-6.
47. Ozer F, Ozer C, CagiciCA, Canbolat T, YilmazerC, Akkuzu B.
Surgical approaches for antrochoanal polyp: Acomparative analysis.
B-Ent 2008;4:93-9.
48. AtighechiS, BaradaranfarMH, KarimiG, JafariR. Antrochoanal
polyp: Acomparative study of endoscopic endonasal surgery alone
and endoscopic endonasal plus mini-caldwell technique. Eur Arch
Otorhinolaryngol 2009;266:1245-8.
49. HongSK, MinYG, KimCN, ByunSW. Endoscopic removal of the
antral portion of antrochoanal polyp by powered instrumentation.
Laryngoscope 2001;111:1774-8.
50. Perić A, Vukadinović T, Kujundžić T, Labus M, Stoiljkov M,
Đurđević BV. Choanal polyps in children and adults: 10-year
experience from a tertiary care hospital. Eur Arch Otorhinolaryngol
2019;276:107-13.
51. El-Anwar MW, Elmalt A, Annany A, Ahmed WA, Nofal AA.
Topical mitomycin C application post endoscopic removal of
antrochoanal polyp. Laryngoscope Investig Otolaryngol 2021;6:
619-22.