Frontochoanal polyp and silent sinus syndrome

Case contributed by Dr Yair Glick

Presentation

Difficulty with nasal breathing on left.

Patient Data

Age: 75 years
Gender: Male

Frontal sinus completely opacified on left.

Frontochoanal polyp.

Small left maxillary sinus with mucosal thickening, bubbly secretion, and thickened outer walls.

Cavernous segment of ICA bilaterally exhibits extensively calcified atheromatous plaque.

CT

Post-operational CT

Status post-FESS, including extensive polypectomy and left maxillary antrostomy.

Case Discussion

The patient had been suffering from nasal and paranasal polyposis. This included an extremely long frontochoanal polyp, a frontal polyp passing through the nasal cavity into the nasopharynx via the choanal opening. This is a rare condition, much less common than an antrochoanal polyp.

The left maxillary sinus is discernably smaller than the right one, with thickened, sclerosed anterior and lateral walls. Coupled with the patient's history of chronic infundibular obstruction due to sinonasal polyposis, the findings are suggestive of silent sinus syndrome.

He subsequently underwent FESS, which included sinonasal polypectomy and debridement as well as left maxillary antrostomy, with satisfactory clinical results.

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Case information

rID: 55956
Case created: 2nd Oct 2017
Last edited: 31st Oct 2017
System: Head & Neck
Inclusion in quiz mode: Included
Institution: Hillel Yaffe Medical Center

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