Antrochoanal Polyp

Antrochoanal Polyp

Q. 1

All are true about Antrochoanal polyp EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Q. 1

All are true about Antrochoanal polyp EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Ans. C

Explanation:

Avulsion is the treatment of choice 

TREATMENT OF ANTROCHOANAL POLYP:

An antrochoanal polyp is easily removed by avulsion (Avulsion Polypectomy) either through the nasal or oral route. Recurrence is uncommon after complete removal. In cases which do recur, Caldwell-Luc operation may be required to remove the polyp completely from the site of its origin and to deal with co-existent maxillary sinusitis. These days, endoscopic sinus surgery (treatment of choice) has superceded other modes of polyp removal. Caldwell-Luc operation is avoided.

DIFFERENCES BETWEEN ANTROCHOANAL AND ETHMOIDAL POLYP:

 

Antrochoanal polyp

Ethmoidal polyp

Age

Common in children

Common in adults

Aetiology

Infection

Allergy or multifactorial

Number

Solitary

Multiple

T.aterality

Unilateral

Bilateral

Origin

Max. sinus near the ostium

Ethmoidal sinuses, uncinate process, middle

turbinate and middle meatus

Growth

Grows backwards to the choana; may hang

down behind the soft palate

Mostly grow anteriorly and may present

at the nares

Size & shape

Trilobed with antral, nasal and choanal parts.

Choanal part may protrude through the choana

& fill the nasopharynx obstructing both sides

Usually small and grape-like masses

Recurrence

Uncommon, if removed completely

Common

Treatment

Polypectomy; endoscopic removal or Caldwell-

Luc operation if recurrent

Polypectomy: Endoscopic surgery or

ethmoidectomy (which may be intranasal,

extranasal or transantral)


Q. 2

The most appropriate management for Antrochoanal polyp in children is:

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 2

The most appropriate management for Antrochoanal polyp in children is:

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Q. 3

Which of the following statement regarding Antrochoanal polyp is false?

 A

It often bleeds to touch

 B

Treatment is avulsion

 C

Arise from maxillary antrum

 D

It is commonly found in children

Q. 3

Which of the following statement regarding Antrochoanal polyp is false?

 A

It often bleeds to touch

 B

Treatment is avulsion

 C

Arise from maxillary antrum

 D

It is commonly found in children

Ans. A

Explanation:

Antrochoanal polyp is a benign polypoidal lesion arising from the maxillary antrum.

It is just an oedematous mucosa and does not bleed to touch.

It is commonly found in children and young adults.

FESS is the treatment of choice.


Q. 4

All are true about Antrochoanal polyp, EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Q. 4

All are true about Antrochoanal polyp, EXCEPT:

 A

Unilateral and single

 B

Grows backwards to the choana

 C

Avulsion is the treatment of choice

 D

Common in children

Ans. C

Explanation:

Antrochoanal polyp are benign lesions that are most commonly seen in children.

This isolated polyp has its origin from the mucosa of the maxillary sinus and extend into choana and nasopharynx.

The major problem is unilateral nasal obstruction. Treatment of choice is primary endoscopic removal with resection of the basis in the maxillary sinus.

Complete removal of the polyp’s base is mandatory to prevent a recurrence.


Q. 5

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 5

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Endoscopic intranasal polyp resection is effective and and is the most popular procedure for the removal of antro choanal polyp even in paediatric patients. 
 
This procedure involves removal of antral portion of the polyp through the enlarged antrostomy with endoscopic visualization, and the nasopharyngeal portion of the polyp is removed transorally if large or transanally if size permits.
 
Caldwell Luc maxillary antrotomy with intranasal antrostomy approach may be useful for complete removal of antral portion of the polyp for minimizing recurrence.
 
 

 


Q. 6

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 6

Which of the following is the MOST appropriate management for antrochoanal polyp in children?

 A

Caldwell Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Intranasal polypectomy is the treatment of choice for antrochoanal polyp in children.

In adults with recurrent antrochoanal polyps the operation of choice is Caldwell Luc operation accompanied by inferior meatus antrostomy.

But this surgery is contraindicated when children develop recurrent polyps as this procedure may hamper the growth of maxilla and present later on as facial deformity.  

Unilateral nasal polyps might represent a neoplastic lesion called antrochoanal polyp. 
 
 
 

Q. 7

Killian term is used for which of the following polyp

 A

Ethmoidal

 B

Antrochoanal

 C

Tonsillar cyst

 D

Tonsillolith

Q. 7

Killian term is used for which of the following polyp

 A

Ethmoidal

 B

Antrochoanal

 C

Tonsillar cyst

 D

Tonsillolith

Ans. B

Explanation:

Q. 8

All the following are true of antrochoanal polyp except: 

 A

Common in children

 B

Single and Unilateral

 C

Bleeds on touch

 D

Treatment involves Avulsion

Q. 8

All the following are true of antrochoanal polyp except: 

 A

Common in children

 B

Single and Unilateral

 C

Bleeds on touch

 D

Treatment involves Avulsion

Ans. C

Explanation:

Q. 9

All of the following are true about antrochonal polyp, except:

 A

Single

 B

Unilateral

 C

Premalignant

 D

Arises from maxillary antrum

Q. 9

All of the following are true about antrochonal polyp, except:

 A

Single

 B

Unilateral

 C

Premalignant

 D

Arises from maxillary antrum

Ans. C

Explanation:

Q. 10

Antrochoanal polyp is characterized by:

 A

Usually bilateral

 B

It is of allergic origin

 C

It arises from maxillary antrum

 D

All

Q. 10

Antrochoanal polyp is characterized by:

 A

Usually bilateral

 B

It is of allergic origin

 C

It arises from maxillary antrum

 D

All

Ans. C

Explanation:

 

Nasal polyps are non-neoplastic masses of edematous nasal or sinus mucosa. They do not bleed on touch and are insensitive to probing and never present with epistaxis or bleeding from nose.

Recurrence is uncommon in case of antrochoanal polyp.

Antrochoanal polyps arise from maxillary artrum and then grow into choana and nasal cavity.

 



Q. 11

The most appropriate management for antrochoanal polyp in children is:

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Q. 11

The most appropriate management for antrochoanal polyp in children is:

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Corticosteroids

 D

Wait and watch

Ans. B

Explanation:

Q. 12

Treatment of choice for antrochoanal polyp in a 10-year ­old child is:

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Conservative treatment till 16 years

 D

Exploratory rhinotomy

Q. 12

Treatment of choice for antrochoanal polyp in a 10-year ­old child is:

 A

Caldwell-Luc operation

 B

Intranasal polypectomy

 C

Conservative treatment till 16 years

 D

Exploratory rhinotomy

Ans. B

Explanation:

 

Management Options for Antrochoanal Polyp 

  • The treatment of antrochoanal polyp is its complete removal along with the removal of the lining of the sinus (to avoid recurrence).
  • Sometimes it is possible to grasp the stalk and avulse the polyp, but most of the time it fails to remove the polyp and its lining completely
  • Therefore, it is not the treatment of choices



Q. 13

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Q. 13

Treatment for recurrent atrochoanal polyp: 

 A

Caldwell Luc operation 

 B

FESS

 C

Simple polypectomy

 D

Both a and b

Ans. B

Explanation:

Q. 14

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Q. 14

The current treatment of choice for a large antrochoanal polyp in a 10 year old is: 

 A

Intranasal polypectomy

 B

Caldwell Luc operation

 C

FESS

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

Q. 15

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Q. 15

The current treatment of choice for a large antrochoanal polyp in a 30-year-old man is:

 A

Intranasal polypectomy

 B

Caldwell-Luc operation

 C

FESS (Functional Endoscopic Sinus Surgery)

 D

Lateral rhinotomy and excision

Ans. C

Explanation:

 

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery which has superceded other modes of polyp removal in all age groups.
  • In this procedure all polyps are removed under endoscopic control especially from the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred
  • Caldwell-Luc operation is avoided these days.

Q. 16

“Bernoulli’s theorem” explains:

 A

Nasal polyp

 B

Thyroglossal cyst

 C

Zenker’s diverticulum

 D

Laryngomalacia

Q. 16

“Bernoulli’s theorem” explains:

 A

Nasal polyp

 B

Thyroglossal cyst

 C

Zenker’s diverticulum

 D

Laryngomalacia

Ans. A

Explanation:

 

Bernoulli’s theorem states that if the speed of a fluid element increases as it travels along a horizontal streamline, the fresher of the fluid must decrease and conversely.                               —Fundamental of Physics, Halliday Resnic 6th/ed

Nasal polyps follow Bernoulli’s theorem as The increased speed of the air flowing through the nose decreases the pressure in the nasal cavity (Bernoulli’s theorem) which pulls down the polyp.



Q. 17

Topical steroids are not recommended post-surgery for:

 A

Allergic fungal sinusitis

 B

Chronic rhinosinusitis

 C

Antrochoanal polyp

 D

Ethmoidal polyps

Q. 17

Topical steroids are not recommended post-surgery for:

 A

Allergic fungal sinusitis

 B

Chronic rhinosinusitis

 C

Antrochoanal polyp

 D

Ethmoidal polyps

Ans. C

Explanation:

 

Topical steroids are not recommended in post surgery for antrochoanal polyps.

For antrochoanal polyps, cause is infection and not the allergy.

Antrochoanal polyps are single, unilateral and rarely recur.

Topical steroids are rarely recommended.


Q. 18

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Q. 18

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following would be the best management for the patient?

 A

FESS with polypectomy

 B

Medial maxillectomy (TEMM)

 C

Caldwell-Luc procedure

 D

Intranasal polypectomy

Ans. A

Explanation:

A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. FESS with polypectomy would be the best management for the patient.

FESS (Functional Endoscopic Sinus Surgery):

  • Current treatment of choice of antrochoanal polyp is endoscopic sinus surgery, which has superseded other modes of polyp removal.
  • In this procedure, all polyps are removed under endoscopic control especially from the the key area of the osteomeatal complex. This procedure helps to preserve the normal function of the sinuses. FESS can be done under local anesthesia although general anesthesia is preferred.



Q. 19

Topical steroids are not recommended in:

 A

Post surgery for antrochoanal polyps

 B

Post surgery for ethmoidal polyps

 C

Post surgery for chronic rhinosinusitis

 D

Post surgery for allergic fungal sinusitis

Q. 19

Topical steroids are not recommended in:

 A

Post surgery for antrochoanal polyps

 B

Post surgery for ethmoidal polyps

 C

Post surgery for chronic rhinosinusitis

 D

Post surgery for allergic fungal sinusitis

Ans. A

Explanation:

 

Topical steroids are not recommended in post surgery for antrochoonol polyps.

For antrochoanal polyps, cause is infection and not the allergy. Antrochoanal polyps are single, unilateral and rarely recur. Topical steroids are rarely recommended.


Q. 20

Antrochoanal polyp is associated most commonly with ‑

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Sphenoethmoidal recess

Q. 20

Antrochoanal polyp is associated most commonly with ‑

 A

Superior meatus

 B

Inferior meatus

 C

Middle meatus

 D

Sphenoethmoidal recess

Ans. C

Explanation:

 

ANTROCHOANAL POLYP

Antrochoanal polyp is non-cancerous growth arising from the mucous membrane of the maxillary sinus and reaches the opening of the sinus in the nasal cavity through the opening of maxillary sinus in the middle  meatus.

It is single and unilateral, i.e. it occurs in one of the maxillary sinus. It arises from maxillary sinus and grows backward in the nose towards the choana and may reach the nasopharynx.

Generally occurs in young age group (children and young adults) and is more common in male. Exact etiology is not known, However sinus infection has been incriminated (in contrast to ethmoidal polyp, which is considered as allergic).

Clinical features of antrochoanal polyp

  • Unilateral Nasal blockage (more on expiration than on inspiration)
  • Obstruction may become bilateral when polyp grows into nasopharynx and starts obstructing opposite choana.
  • Hyponasal voice
  • Mucoid nasal discharge
  • Conductive deafness due to eustachian tube dysfunction
  • On examination, polyp may not be visible on anterior rhinoscopy as it grows posteriorly
  • On posterior rhinoscopy – smooth, greyish white, spherical mass is seen in choana.

Treatment of antrochoanal polyp

  • There is no medical treatment for antrochoanal polyp. The treatment of choice is complete surgical removal of polyp along with removal of lining of maxillary sinus to prevent the recurrence. Surgeries for antrochoanal polyp include :‑

1) Avulsion of a polyp

  • The stalk of the polyp is grasped and gently moved around to tease out the antral lining.
  • Most of the time, avulsion fails to remove the polyp and antral lining completely.

2) Intranasal polypectomy

  • It was the treatment of choice for all age groups prior to the advent of endoscopic sinus surgery and is still the treatment of choice in those setups where endoscopic surgery is not practised.

3) Caldwell Luc operation

  • It is indicated if there is a recurrence and the age of the patient is more than 17 years.
  • Now a days with FESS available – Caldwell luc operation is avoided.

Q. 21

Xray showing air column between soft tissue mass and posterior wall of nasopharynx is suggestive of ‑

 A

Ethmoidal polyp

 B

Antrochoanal polyp

 C

Nasal myiasis

 D

None of the above

Q. 21

Xray showing air column between soft tissue mass and posterior wall of nasopharynx is suggestive of ‑

 A

Ethmoidal polyp

 B

Antrochoanal polyp

 C

Nasal myiasis

 D

None of the above

Ans. B

Explanation:

Ans. is b’ i.e., Antrochoanal polyp

On xray,antrochoanal polyp appears as a soft tissue density and shows a column of air between the soft tissue mass and posterior wall of nasopharynx.



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