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Clinical Problem Solving: Radiology
April 2005

Radiology Quiz Case 1: Diagnosis

Arch Otolaryngol Head Neck Surg. 2005;131(4):368. doi:10.1001/archotol.131.4.368

Diagnosis: Right antrochoanal polyp (ACP)

The patient underwent endoscopic resection of the polyp under general anesthesia. After the extramaxillary portion of the polyp was excised through the oropharynx because of the large size of the tumor, the maxillary sinus was opened and revised and the intramaxillary portion of the cyst was resected. The patient’s dyspnea, dysphagia, and voice impairment resolved after surgery.

An ACP is a benign mass that originates in the mucosa of the maxillary sinus (formerly known as the antrum of Highmore) and grows through the ostium to the nasal cavity and the choana.1 Antrochoanal polyps are also known as Killian polyps, since Gustav Killian2 was the first scientist to describe their maxillary origin, in 1906. They have epidemiologic and clinical features that are different from those of bilateral nasal polyposis. Unlike nasal polyposis, ACPs usually occur in a unilateral pattern, with only 2 bilateral cases reported in the literature (to our knowledge) ,3,4 and they usually appear in younger patients.5

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