Antrochoanal Polyps: How Long Should Follow-Up Be after Surgery?

Hindawi Publishing Corporation International Journal of Otolaryngology Volume 2015, Article ID 297417, 5 pages http://dx.doi.org/10.1155/2015/297417 Clinical Study Antrochoanal Polyps: How Long Should Follow-Up Be after Surgery? Saisawat Chaiyasate,1 Kannika Roongrotwattanasiri,1 Jayanton Patumanond,2 and Supranee Fooanant1 1 Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50000, Thailand Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand 2 Correspondence should be addressed to Saisawat Chaiyasate; Received 30 June 2015; Accepted 21 July 2015 Academic Editor: David W. Eisele Copyright © 2015 Saisawat Chaiyasate et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To investigate the length of follow-up needed to detect recurrence of antrochoanal polyps. Methods. A retrospective investigation was performed on patients who had been operated on with a preoperative diagnosis of antrochoanal polyps in Chiang Mai University hospital from 2006 to 2012. Results and Discussion. Of the 38 cases of choanal polyps, 27 were adults (71%). The median age was 23.5, ranging from 7 to 64 years old. Eighteen patients were male (47.4%). The origin of choanal polyps was the maxillary antrum in 32 patients. The most common symptom was nasal obstruction (97.4%). The surgical procedures were polypectomy in one child and combined endoscopic and transcanine fossa approach in two adults. The remainder of the patients underwent endoscopic removal of the polyps. The follow-up time ranged from 1 day to 8 years. There were 5 cases of recurrence of which four were in children. The time for recurrence was 1.2 ± 0.6 years (95% CI 0.51, 1.97). Conclusion. Antrochoanal polyps are more common in younger patients. Recurrence was significantly higher in children. Follow-up of patients should be for at least 2 years postoperatively in order to detect 95% of recurrence. 1. Introduction The condition of antrochoanal polyps (Killian polyps) is a distinctive clinical disease. It is characterized by polyps originating from the maxillary antrum, which then extend through the natural or accessory ostium into the nasal cavity, choana, and nasopharynx. The maxillary portion is cystic though there are some reports of solid forms (polyps), while nasal and choanal portions are usually solid [1]. Choanal polyps may come from the sphenoid sinus, the nasal septum, and other parts of the nasal cavity [2–4]. Antrochoanal polyps occur as 4–6% of adult polyps [5] and 33% of childhood polyps [6]. The most common presenting symptom is nasal obstruction, either unilateral or bilateral. Other complaints are rhinorrhea, sinusitis, snoring, dysphagia, and so forth. Complete surgical removal of the nasal and antral portion of the polyp is the standard treatment to prevent recurrence. However, in some patients with a small maxillary sinus or in revision cases, the origin of the polyp could not be well identified. This study is to investigate the length of follow-up needed to detect recurrence of polyps in patients. The authors also would like to discern if there are differences in recurrence between children and adults. 2. Materials and Methods A retrospective investigation was carried out on patients who had been operated on with a preoperative diagnosis of antrochoanal polyps in Chiang Mai University hospital from 2006 to 2012. After excluding 6 cases of inverted papilloma and 1 case of maxillary mucopyocele, 38 cases of patients with choanal polyps were included in this study. Clinical data and operative findings were reviewed, and the latest follow-up data were collected. Delayed diagnosis was defined as treating patients with another diagnosis such as sinusitis or allergic rhinitis for more than 3 visits to the outpatient document without recording incidence of polyps. The treatment of antrochoanal polyps was complete surgical 2 International Journal of Otolaryngology Table 1: Patient characteristics according to age group. Total (38 patients) Age <15 years (11 patients) Age ≥15 years (27 patients) Age (year) Mean ± SD Median 23.5 28.1 ± 16.3 10.7 ± 2.6 35 ± 14 Range Sex Male : female 7–64 7–14 15–64 6:5 12 : 15 0.724 11 (100%) 26 (96.3%) 1.000 7 (63.6%) 4 (36.4%) 0 15 (55.6%) 11 (40.7%) 1 (3.7%) Symptoms Nasal obstruction 37 (97.4%) Unilateral Bilateral None 𝑝 value Positional change Progression 9 (23.7%) 3 (27.3%) 10 (90.9%) 6 (22.2%) 17 (63%) 1.000 0.124 Purulent rhinorrhea Epistaxis Pain 27 (71.1%) 5 (13.2%) 10 (26.3%) 9 (81.8%) 2 (18.2%) 2 (18.2%) 18 (66.7%) 3 (11.1%) 8 (29.6%) 0.452 0.615 0.690 Sore throat Delayed diagnosis 3 (7.9%) 9 (23.7%) — 1 (9.1%) 3 (11.1%) 8 (29.6%) 0.542 0.237 Follow-up Less than a month Median (year) 7 (18.4%) 1.22 2 (18.2%) 1.24 5 (18.5%) 1.20 0.721 1 day–8 years 1 day–7 years 1 day–8 years Range Operation Endoscopic polypectomy 1 — Endoscopic removal Combined endoscopic and transcanine fossa 10 — 25 2 Origin Maxillary sinus Sphenoethmoidal recess/superior turbinate 11 — 21 6 4 (36.4%) 1 (3.7%) Recurrence removal with either an endoscopic approach alone or an endoscopic approach combined with the transcanine fossa approach. The data were analyzed using the STATA program version 11.0 (STATA Corporation, Texas, USA). The exact probability test was used for the proportion of the investigative variables between the age groups, and survival analysis was used for evaluating the potential factors affecting recurrence. The Research Ethics Committee of the Faculty of Medicine of Chiang Mai University approved the study protocol. 3. Results Of the 38 cases of choanal polyps, 27 were adults (71%). The median age was 23.5, ranging from 7 to 64 years. Eighteen patients were male (47.4%). There was no statistical difference in the sex of the age groups (Table 1). The origin of choanal polyps was the maxillary antrum in 32 patients. The other polyps originated from the superior turbinate or 0.019 sphenoethmoidal recess, totaling 6 adult patients. The most common symptom was nasal obstruction (97.4%), either unilateral (57.9%) or bilateral (39.5%). Positional changing of the obstruction in the supine or lateral decubitus was found in 9 patients (23.7%). Other symptoms were purulent rhinorrhea (71%), pain (26.3%), epistaxis or bloody nasal discharge (13.2%), and sore throat (7.9%). One adult patient who presented with a sore throat and a mass in the oropharynx for 3 days had no nasal obstruction at all. The duration of symptoms ranged from 3 days to 4.5 years, with a median time of 1 year. When comparing between age groups, the symptoms showed no significant difference. However, purulent rhinorrhea was more common in children (88.8% compared to 66.7%) and pain was more common in adult (...truncated)