International Journal of Head and Neck Surgery
Volume 14 | Issue 4 | Year 2023

Antrochoanal Polyp causing Stridor and Dysphagia: A Case Report of a Rare Presentation

Deepika Pratap1, Suprita S Savadatti2, Manasa K Nagaraj3, Abhishek N Parbat4, Mohammed F Patel5

1Department of Otorhinolaryngology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

2–5Department of Otorhinolaryngology; Department of Head and Neck Surgery, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Corresponding Author: Deepika Pratap, Department of Otorhinolaryngology, Sapthagiri Institute of Medical Science and Research Centre, Bengaluru, Karnataka, India, Phone: +91 9620891691, e-mail:

Received: 17 March 2023; Accepted: 13 April 2023; Published on: 16 January 2024


Background: Antrochoanal polyp (ACP), also known as Killian polyp, is a benign lesion of maxillary sinus origin with infective etiology. ACPs most often present with nasal obstruction and rhinorrhea, but may rarely prolapse causing acute respiratory distress. We herein report a rare case of ACP-causing stridor.

Case description: Large ACPs may extend into the nasopharynx and reach almost up to the epiglottis. A 19-year-old girl presented with nasal obstruction, dysphagia, and stridor. She was diagnosed with left ACP reaching the suprahyoid epiglottis. The patient underwent functional endoscopic sinus surgery (FESS). The postoperative period was uneventful.

Conclusion: Though the ACP is a common lesion, it has various presentations and may extend into the hypopharynx. ACP is managed surgically with complete excision to reduce the risk for recurrence and with less morbidity.

Clinical significance: It is important to keep in mind that ACP when untreated can lead to stridor.

How to cite this article: Pratap D, Savadatti SS, Nagaraj MK, et al. Antrochoanal Polyp causing Stridor and Dysphagia: A Case Report of a Rare Presentation. Int J Head Neck Surg 2023;14(4):63–65.

Source of support: Nil

Conflict of interest: None

Patient consent statement: A written informed consent was obtained from the patient for publication of this article.

Keywords: Antrochoanal, Case report, Dysphagia, Epiglottis, Polyp, Stridor


One of the benign polyps growing from the maxillary sinus and entering the choana is called the ACP. Killian provided the original definition, therefore the name Killian’s polyp (1906). Palfyn, however, made the first mention of it in 1753.1 In the general population, it contributes to 4–10% of nasal polyps and 33% in children, and young people.

Antrochoanal polyp (ACP) is typically unilateral and extends into the nasopharynx; but, in a few rare instances, it can also be bilateral and exit through the choana into the contralateral nasal cavity. ACP can occasionally expand into the hypopharynx, resulting in stridor and dysphagia due to extension in the oropharynx. As ACP often has an infectious etiology, the disease must be surgically eradicated completely to prevent a recurrence.


A 19-year-old girl presented with complaints of left-sided nasal obstruction for 1 year, right-sided nasal obstruction for 6 months, and foreign body sensation in the throat for 2 months. This was associated with difficulty in breathing and swallowing. The patient also noticed a mass in the back of the throat. The patient had a history of recurrent nasal discharge and headaches.

When the patient presented to the otorhinolaryngology outpatient unit, she had inspiratory stridor but was maintaining oxygen saturation. Examination of the nose revealed a grayish mass occupying the left nasal cavity, smooth, insensitive to touch, and which could be probed all around. The mass was causing the bowing of the septum to the right. It did not bleed on touch. Oropharynx and laryngoscopic examination revealed the mass extending up to the suprahyoid epiglottis. The patency of the airway was adequate. Endoscopic nasal examination revealed a left solitary polyp originating from the middle meatus and extending into the nasopharynx, causing total obstruction of the bilateral choana (Figs 1 and 2).

Fig. 1: A grayish polypoidal mass in the left middle meatus

Fig. 2: ACP extending into the oropharynx and hypopharynx

A computed tomography (CT) scan of paranasal sinuses revealed a large soft tissue density lesion in the left maxillary sinus (Fig. 3) extending from the Ostia to the posterior nasal cavity and choana with posterior extension beyond the base of the tongue. Extension into contralateral choana was also noted. No bony erosions were seen. The patient was diagnosed with giant ACP.

Fig. 3: A Homogenous opacity in the left maxillary sinus

The mass was cleared by FESS under general anesthesia (oral intubation was done by a 6 mm cuffed tube). Following infiltration with 2% lignocaine and adrenaline, the left middle meatal antrostomy was done. The mass and stalk attachment were detached from the maxillary sinus wall. The mass was then pulled out orally as a whole using sponge hold forceps. Maxillary sinus walls were scraped off the polypoidal mucosa and the cavity was inspected for any remanent disease. The polyp measured 10 × 3 cm in dimension and was sent for histopathological examination (Fig. 4). Postoperative period was uneventful. Follow-ups at 6 and 12 months showed no recurrence.

Fig. 4: The ACP after endoscopic removal


Nasal obstruction is the most typical symptom of an ACP. Obstructive sleep apnea has also been recognized as a symptom.2 Dysphagia and breathing problems were evident in our patient, which is an unusual sign of an ACP. In our case, full occlusion of the nasal cavity and bending of the contralateral nasal septum concealed the laryngeal intake. Due to the polyp’s descent below the oropharynx, our patient also suffered from dysphagia. The mass’s growing size and weight may result in its autoamputation, which could be deadly and induce stridor.3 Emergent dyspnea and/or dysphagia have only seldom been reported in the literature.4

A 13-year-old boy, with large ACP who occasionally experienced dysphagia and respiratory distress, has been described by Aydin et al.5 Kodur et al. described a case of a 36-year-old man, with large ACP who presented with difficulty in swallowing and a foreign body sensation in his throat.6

The only curative method for ACP is its surgical removal. ACP is treated with various surgical procedures like FESS, polypectomy, and the Caldwell-Luc method.7 In a case report by Khan et al., 91% of patients underwent ACP ectomy with FESS, while 9% of patients got the Caldwell-Luc operation, typically for recurrent ACP.8

Any pedunculated masses that appear in the oropharynx but have no obvious source should be assumed to originate from the paranasal sinuses and nasal cavities. Always perform a thorough examination of the paranasal sinuses and nasal cavities following patient stabilization. The differential diagnosis for these patients has to include ACP.

The three main techniques used to diagnose nasal polyposis are a nasal endoscopy, a CT scan, and magnetic resonance imaging. The differential diagnosis may include ethmoidochoanal polyp, turbinate hypertrophy, adenoidal hypertrophy, Tornwaldt’s cyst, angiofibroma, inverted papilloma,8 and, in extremely rare circumstances, olfactory neuroblastoma, Wegener’s granulomatosis, and rhabdomyosarcoma.9 ACPs are diagnosed by endoscopy in all cases.

Excellent results and low morbidity are related to powered instruments used during the endoscopic excision of an ACP’s antral part.10

The long-used Caldwell-Luc antrostomy has been abandoned in favor of endoscopic sinus surgery because it was shown to harm the maxillary bone’s growth centers cause cheek or tooth inflammation, and/or induce anesthesia.11


Though ACP is a common lesion, it has various presentations and may extend into the hypopharynx. ACP is managed surgically with complete excision to reduce the risk for recurrence and with less morbidity.

Clinical Significance

It is important to keep in mind that ACP when untreated can lead to stridor.


Deepika Pratap

Suprita S Savadatti

Manasa K Nagaraj

Abhishek N Parbat

Mohammed F Patel


1. Frosini P, Picarella G, De Campora E. Antrochoanal polyp: analysis of 200 cases. Acta Otorhinolaryngol Ital 2009;29(1):21–26. PMID: 19609378.

2. Venkatachalam VP, Gupta N, Suri JC, et al. Antrochoanal polyp-a cause of obstructive sleep apnoea in children. Indian J Otolaryngol Head Neck Surg 1998;50(1):92–94. DOI: 10.1007/BF02996787

3. Kolwadhkar BP, Ankale NR, Bagewadi SB, et al. Unusual presentation of an antrochoanal polyp. BHJ 2005;47(1):82–83. DOI: 10.11604/pamj.2017.26.233.12054.eCollection2017

4. Frosini P, Picarella G, Casucci A. An unusual case of antrochoanal polyp with sudden laryngeal dyspnoea and stridor onset. Acta Otorhinolaryngol Ital 2008;28(4):212–214. PMID: 18939711.

5. Aydın S, Çakan D, Öztürk S, et al. Giant antrochoanal polyp: a case report. South Clin Istanb Eurasia 2018;29(4):310–312. DOI: 10.14744/scie.2018.98698

6. Kodur S, Siddappa SM, Shivakumar AM. Giant antrochoanal polyp-a rare presentation. J Clin of Diagn Res 2017;11(1):MD01–MD02. DOI: 10.7860/JCDR/2017/23639.9285

7. Yaman H, Yilmaz S, Karali E, et al. Evaluation and management of antrochoanal polyps. Clin Exp Otorhinolaryngol 2010;3(2):110–114. DOI: 10.3342/ceo.2010.3.2.110

8. Khan Qaisar, Fazal-I-Wahid, Khan Asgharullah, et al. Antrochoanal polyps: presentation and management. KJMS 2013;6(2):256–259. DOI: 10.13188/2380-0569.1000026

9. Lopatin A, Bykova V, Piskunov G. Choanal polyps: one entity, one surgical approach? Rhinology 1997;35:79–83. PMID: 9299656.

10. Hong SK, Min YG, Kim CN, et al. Endoscopic removal of the antral portion of antrochoanal polyp by powered instrumentation. Laryngoscope 2001;111(10):1774–1778. DOI: 10.1097/00005537-200110000-00021

11. Basak S, Karaman CZ, Akdilli A, et al. Surgical approaches to antrochoanal polyps in children. Int J Pediatr Otolaryngol 1998;46(3):197–205. DOI: 10.1016/s0165-5876(98)00160-8

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