Braz. j. . vol.80 número4

BrazJOtorhinolaryngol.2014;80(4):362---363

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

www.bjorl.org

CASE

REPORT

Nasal

obstruction

due

to

septochoanal

polyp

夽

Obstruc

¸ão

nasal

por

pólipo

septocoanal

Hyun

Sang

Cho,

Kyung

Soo

Kim

DepartmentofOtorhinolaryngology---HeadandNeckSurgery,Chung-AngUniversityCollegeofMedicine,Seoul,SouthKorea

Received4December2012;accepted12January2013 Availableonline12June2014

Introduction

Choanalpolypsareoneformofthenasalpolypsthatgrow towardthechoanawithasinglestalk.1_{Septochoanalpolyp}

is a rare entity that originates from the mucosa of the nasalseptumwithchoanalextension,2_{andthreecaseshave}

beenreportedtodate.2---4_{Thisarticlereportsanadditional,}

newcaseofseptochoanalpolyp,togetherwithaliterature review of its clinical features, pathogenensis, and treat-mentoptions,inordertoincreasetheunderstandingofthis unusualchoanallesion.

Case

report

A 59-year-old woman presented to this department with left-sidednasal obstruction of twomonths’duration. The conditionhad become progressivelyworseover time,and uponvisitingthe localENTclinic,a nasalmasswasfound ontheleftchoana.Endoscopicnasalexaminationrevealed aunilateral massbasedinthe superioraspect ofthe pos-teriorportionofthenasalseptumintheleftnasalcavity. Therewasathinpedicle,andthepolypwashangingloosely

夽

Pleasecitethisarticleas:ChoHS,KimKS.Nasalobstructiondue

toseptochoanalpolyp.BrazJOtorhinolaryngol.2014;80:362---3.

∗_{Correspondingauthor.}

E-mail:99-21045@hanmail.net(K.S.Kim).

through the choana (Fig. 1A and B). Computed tomogra-phydemonstrateda1.7cm×0.9cm×1.2cmlobulatedand

pedunculatedmass,originatingfromtheleftnasalseptum, which protruded into the nasopharynx without any sinus involvement(Fig.1DandE).

Underlocalanesthesia,themasswascompletelyexcised usingendoscopicinstrumentation. The base ofthe lesion, includingthehealthymucosaoftheleftposteriorseptum, wasremovedandcauterizedusingsuctioncauteryfor pre-vention of recurrence (Fig. 1C). Histological examination revealed chronicinflammatorypolyp.Therewerenosigns ofrecurrenceduringafollow-upperiodof12months.

Discussion

Basedonthesitesoforigin,choanalpolypsareclassifiedas antrochoanal,sphenochoanal,andethmochoanal.2_Although

thelocationofoccurrenceofchoanalpolypsvaries,choanal polyps arising from the nasal septum are known to be very rare.2---4 _{Choanal polyp arising from the nasal}

sep-tum was first reported by Bailey in 1979,3 _{and the term}

‘‘septochoanal polyp’’ was used for this rare lesion by Birkentin2009.2

Septochoanalpolyps arebenign,unilateral, andinvade the posterior nasal cavity through the nasopharynx. The most common site of their origin is mainly the superior aspect of the posterior portion of the nasal septum.2---4

http://dx.doi.org/10.1016/j.bjorl.2014.05.024

1808-8694/©2014Associac¸ãoBrasileiradeOtorrinolaringologia eCirurgiaCérvico-Facial. PublishedbyElsevierEditoraLtda.All rights

Nasalobstructionduetoseptochoanalpolyp 363

NS

NS

NS MT

MT

MT

A

D

E

B

C

Figure1 EndoscopicviewandPNSCTfindings.(A)Close-upviewofthenasalpolypbasedintheleftposteriorseptum(whitish arrow,pedicle;NS,nasalseptum,MT,middleturbinate).(B)Pediclebetweenthenasalpolypandthenasalseptumisnoted.(C) Postoperativeendoscopicappearanceshowsclearleftchoanawiththepediclesitecauterizedontheposteroinferiorseptum.(D andE)Computedtomography(D,axial;E,coronal)showstheleftchoanalpolyporiginatingfromtheseptumprotrudingintothe nasopharynx(blackarrow,originsite).

Pathogenically, Mills et al. have reported that choanal polyps arisefromthe recoveryprocessof sinusitis,where there is expansion of mucinous cyst resulting from the obstructionandruptureofthemucousgland.5_Clinical

pre-sentationsofseptochoanalpolypsincludenasalobstruction andsnoring.2---4_{Preoperativedetectionofthepolyporiginby}

nasalendoscopymaybeimportantfordifferentialdiagnosis andsurgicalplanning.Characteristicallyinendoscopic find-ings,thereisapedicleinthenasalseptum,withthemain polypoidmassinthechoana.3_{AlthoughCTisnotessential}

forthediagnosis,itallowsforaccurateconfirmationofsinus involvementandoriginsite.

For differential diagnosis of nasopharyngeal tumors, benign tumors such as juvenile angiofibroma, teratoma, meningoencephalocele,chordoma,paraganglioma,inverted papilloma,adenoidhypertrophy,andangiofibromaneedto beruledout.6

Ifchoanalpolypshaveanendoscopicallyprovenpedicle onthenasalseptumwithoutsinus involvement,the treat-mentofchoiceisendoscopicsurgeryunderlocalanesthesia. Becausethe recurrenceratefor choanalpolyps after sur-gicaltreatment isreportedtobe26.6%,theseptochoanal polypsmustbecompletelyremovedbyendoscopicsurgery, andresectionofasmallamountofhealthymucosa surround-ingthepointoforiginofthepedicleisnecessaryinorderto preventrecurrence.1

Final

remarks

Althoughchoanalpolypsarisingfromthenasalseptumare knowntobeveryrare,septochoanalpolypmustbeincluded inthedifferentialdiagnosisofchoanalmass-likelesions.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

References

1.SlirolaR.Choanalpolyps.ActaOtolaryngol.1966;61:42---8.

2.BirkentH,KarahatayS,DurmazA,KurtB,TosunF.Choanalpolyp originating from thenasal septum:septochoanalpolyp.Kulak BurunBogazIhtisDerg.2009;19:163---6.

3.Bailey Q.Choanalpolyp arisingfrom theposteriorendofthe nasalseptum.JLaryngolOtol.1979;93:735---6.

4.OzgirginON,KutluayL,AkkuzuG,GungenY.Choanalpolyp orig-inatingfromthenasalseptum:acasereport.AmJOtolaryngol. 2003;24:261---4.

5.MillsCP.Secretarycystsofthemaxillaryantrumandtheir rela-tiontothedevelopmentofantrochoanalpolyp.JLaryngolOtol. 1959;73:324---34.