Antrochoanal polyp in pediatric age group

Antrochoanal polyp (ACP) is a benign solitary polypoid lesion affecting mainly adults and rarely children. It originates from a hypertrophy of the mucous membrane of the maxillary sinus antrum, and grows through the maxillary sinus ostium towards the nasal cavity and the choana. The clinical data and imaging studies of 39 children with ACP were reviewed. The most commonly affected age group was from 10 to 15 years. Clinical presentations included nasal obstruction, rhinorrhea; and rarely, bloody discharge. Ig-E-mediated allergy was established in 61.5% of the patients and only 17.9% of patients had history of asthma. 92.3% of patients had aberrant nasal anatomy, including septal deviation, pneumatized middle turbinate, and inferior turbinate hypertrophy. The development of ACP could be due to an increased pressure level within the maxillary sinus caused by obstruction of the sinus natural ostium and/or anatomical alteration at the ostiomeatal complex at middle meatus level, in a patient with a pre-existing silent antral cyst, subsequently forced to herniate outside, through the sinus fontanelle. For treatment, we suggest performing wide middle meatotomy in addition to correction of all the predisposing anatomical factors.