Bilateral Antrochoanal Polyps :A rare variation of a common clinical entity

Abstract

Introduction: Antrochoanal polyps (ACPs) are benign, typically unilateral lesions originating from the maxillary sinus mucosa. While they commonly extend into the nasopharynx, bilateral occurrence is exceedingly rare, and extension into the oropharynx represents an unusual clinical presentation that can lead to airway compromise and dysphagia.

 

Case Presentation: An 18-year-old male presented with a 1.5-year history of progressive bilateral nasal blockage, headache, and hyponasal voice. Examination revealed pale polypoidal tissue completely obstructing both nasal cavities and extending inferiorly to obliterate the oropharynx. Contrast-enhanced computed tomography (CECT) confirmed bilateral soft tissue masses originating from both maxillary sinuses with significant oropharyngeal extension. The patient underwent Functional Endoscopic Sinus Surgery (FESS) utilizing a combined trans-oral and trans-nasal approach to safely deliver the massive 11 x 7 x 3 cm specimen. Histopathology confirmed a benign inflammatory antrochoanal polyp.

 

Discussion and Conclusion: Bilateral ACPs with oropharyngeal involvement represent a severe "fourth stage" of growth that mimics oropharyngeal malignancy. Diagnosis relies on CECT to assess bony anatomy and the widening of the maxillary ostia. Surgical management via FESS is the treatment of choice, though massive polyps may require a combined approach to ensure complete clearance and prevent recurrence. Postoperatively, the patient experienced complete relief of symptoms.