A patient with antrochoanal polyp (ACP) undergoes FESS. Unlike ethmoidal polyps, an ACP arises from which location, and what is the appropriate surgical approach?

• A Floor of maxillary sinus; FESS with middle meatal antrostomy and endoscopic removal of both antral and choanal components ✓
• B Posterior wall of maxillary sinus; Caldwell-Luc operation alone
• C Mucoperiosteum of inferior meatus; inferior meatal antrostomy with polypectomy
• D Ethmoid bulla extending into the antrum; conventional polypectomy via nasal cavity

Explanation

Antrochoanal polyp (Killian's polyp) arises from the mucosa of the maxillary antrum (typically the posterior, inferior, or lateral wall), traverses the maxillary ostium or accessory ostium, passes through the middle meatus, and extends into the nasopharynx via the choana. Correct surgical management via FESS requires middle meatal antrostomy (to access and excise the intramaxillary antral cyst/polyp base) combined with complete removal of the choanal portion endoscopically. Simply avulsing the choanal portion leaves the antral root and causes recurrence — the key difference from ethmoidal polyps.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.