From adenoidectomy to endoscopic sinus surgery: a case of recurrent antrochoanal polyp in a child

General Medicine, 2025, 27(4), 36-41.

S. Markov^{1, 2}, P. Markova^{3, 4}

¹ Department of Otorhinolaryngology, Faculty of Medicine, Medical University – Plovdiv
² Department of Otorhinolaryngology, UMHAT “Sv. Georgi” – Plovdiv 3Department of Pediatrics, Faculty of Medicine, Medical University – Plovdiv 4Department of Pediatrics, UMHAT “Sv. Georgi” – Plovdiv

Abstract. Introduction: Antrochoanal nasal polyposis is a condition affecting both children and adults, though it occurs much less frequently than classical bilateral nasal polyposis. The primary symptom is unilateral nasal obstruction, which may progress to bilateral obstruction as the polyp develops. Head pressure, headaches, facial pain, and reduced sense of smell are less commonly observed accompanying symptoms. Diagnosis is based on medical history, clinical findings –unilateral soft tissue mass presence originating from the maxillary sinus and prolapsing toward the choanae and imaging studies (Computed Tomography or Magnetic Resonance Imaging). Surgical removal of the polyp remains the main treatment method, with functional endoscopic sinus surgery being the current surgical technique providing the best outcomes. Case Description: We present a clinical case of an 11-year-old girl diagnosed with a choanal polyp at the age of 6 during surgical removal of adenoid vegetation. The polyp was also excised through polypectomy. Due to recurrence, the young patient underwent revision surgery – an antrotomy was performed using functional endoscopic sinus surgery. Discussion: Antrochoanal polyposis is a benign condition originating from the maxillary sinus. In children, the differential diagnosis includes various benign and malignant nasal tumors, chronic rhinitis with nasal polyps, and most commonly, adenoidal hyperplasia. The condition does not undergo malignant transformation, and with an appropriate surgical approach, recurrences are rare. Conclusion: In children with persistent nasal obstruction, as well as in those unsuccessfully treated for chronic rhinitis or adenoidal hyperplasia over an extended period, choanal polyposis should be considered in the differential diagnosis.

Key words: antrochoanal polyp, choanal polyp in children, unilateral nasal obstruction in children

Address for correspondence: Dr. Stoyan Markov, e-mail: Stoyan.Markov@mu-plovdiv.bg