Case report
Sphenochoanal polyp: endoscopic surgery

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Abstract

Sphenochoanal polyp is a rare entity originating from sphenoid sinus. It may be confused with antrochoanal polyp on anterior rhinoscopy because of its similar appearance. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. Destructive external approaches to gain access to the sphenoid sinus are also not advisable in children for a benign disease. We present two cases of sphenochoanal polyps in two children that were operated by endonasal endoscopic approach. They were free of symptoms after surgery. No complications and recurrences were observed at 28 and 18 months of follow-up periods respectively.

Introduction

Sphenochoanal polyp is a benign, solitary mass, which originates from the sphenoid sinus. After emerging from the sphenoid ostium it passes through the choana and extends to the nasopharynx. In contrast to common nasal polyposis and antrochoanal polyps it is a rare entity. Generally it has a cystic part inside the sinus like the antrochoanal polyp. Its morphological appearance is also similar to other choanal polyps. The identification of the sinus, which the polyp originates, may be difficult by either physical examination or classical X-ray. As a result, sphenochoanal polyps may have been underdiagnosed for many years before the introduction of the CT and nasal endoscopy. A few case reports addressing the successful resection of sphenochoanal polyps under endoscopic vision have appeared in the literature in recent years [1], [2], [3].

Almost fifty percent of the sphenochoanal polyps were reported in children [1], [2], [4]. Destructive surgery to the nasal bones such as transseptal sublabial transseptal approach to the sphenoid sinus is not preferable during growth. We present two cases of sphenochoanal polyps in two children who were successfully treated by endonasal endoscopic approach.

Section snippets

Case 1

A 15-year-old boy had complaints of nasal obstruction, rhinorrhea and headache for 1 year. Anterior rhinoscopy showed a solitary, polypoid mass in the right nasal passage. The nasal mucosa was inflamed, swollen and was covered with copious mucoid secretion. Posterior rhinoscopy also showed a polypoid mass filling the nasopharynx. Opacification of the right nasal cavity, right sphenoid sinus and the entire nasopharynx was seen on coronal computerized tomography (CT) of the paranasal sinuses.

Discussion

The first report of sphenochoanal polyp is attributed to Zuckerkandl in 1892 [5]. Since then only a few reports on this issue appeared in the literature in recent years. Improvement of imaging techniques and introduction of rigid nasal endoscopes may contribute to the diagnosis of these lesions. Sphenochoanal polyp is different from common nasal polyposis as it is a solitary mass and has a pedicle arising from the mucosa of the sphenoid sinus. Histologically, sphenochoanal polyp and

Conclusion

In conclusion, sphenochoanal polyp is a rare form nasal polyp. CT scanning of the paranasal sinuses and endoscopic nasal examination usually establishes the diagnosis. Total excision of the sphenochoanal polyp with the cystic part inside the sphenoid sinus by endonasal endoscopic approach was accomplished in the presented two cases and no recurrence was observed in the follow-up period.

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