Antrochoanal Polyp endoscopic excision

By

Dr. T. Balasubramanian M.S. D.L.O.

Antrochoanal polyp arises from maxillary antrum.  It exists through an enlarged accessory ostium and enters the nasal cavity.  It will exit through the choanal orifice and present itself in the nasopharynx. 

This surgery is performed using a nasal endoscope.  The nasal cavity is packed with roller gauze impregnated with 4% xylocaine mixed with 1 in 10,000 adrenaline.  One pack is placed in the inferior meatus, one is placed in them middle meatus and the third one is placed in the floor of the nose.

As a first step uncinate process is removed using a back biting forceps.  The uncinate process must be removed completely.  The maxillary sinus ostium is clearly visualised.  In this patient as soon as the uncinate process is removed pus can be seen streaming out from the infundibulum.  Most probably the polyp was obstructing the drainage of the infundibulum.

The polyp is removed by avulsing it using a straight Blakesley forceps.  A continuous gentle traction is sufficient to dislodge the polyp.  The antral component can be separately removed using a 45 degree Blakesley forceps.


After the procedure the middle meatus is packed with gelfoam.  This pack will prevent undesirable synechiae developing in the nasal cavity.