Saout Arrih B, Bijou W, Oukessou Y, Rouadi S, Abada R, Mahtar M
Department of Otolaryngology, Head and Neck Surgery, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Department of Otolaryngology, Head and Neck Surgery, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Int J Surg Case Rep. 2025 Jul 31;134:111744. doi: 10.1016/j.ijscr.2025.111744.
Despite being non-neoplastic and usually unilateral, antro-choanal polyps have a notable tendency to recur following surgical treatment, particularly when incomplete removal of the polyp's antral portion occurs. Understanding the mechanisms and risk factors associated with ACP recurrence is crucial for optimizing treatment strategies and minimizing the likelihood of relapse. The main objective of this study was to identify and analyze the prognostic factors associated with recurrence of this benign but potentially recurrent pathology.
This is a retrospective study of a series of 27 patients operated for an antrochoanal polyp (ACP). The study was carried out over a five-year period, from January 2, 2017 to July 5, 2024. All patients, regardless of age or sex, who underwent surgery for an antrochoanal polyp during this period were included in the study.
A total of 21 patients had no recurrence during follow-up. Of these, 14 patients (67 %) underwent endoscopic nasal endoscopy with meatotomy. However, 7 patients (33 %) underwent Caldwell-Luc (CWL) approach associated with endoscopic surgery. Recurrence was noted in 6 patients (22.22 %). The mean time to recurrence was 22 months, of which 4 (66 %) recurred before 16 months. We found that 50 % of patients who recurred (3 cases) were aged between 13 and 36, 17 % were under 13 (1 case) and 33 % were over 36 (2 cases). Recurrences were equally distributed between the genders, with a sex ratio of 1. All patients who had recurrence were of urban origin. Three patients, i.e., 50 % of those who recurred, had a rhino-sinus history. All patients who had relapsed underwent exclusive endonasal endoscopy with middle meatotomy for removal of the sinus component of ACP. Also, all patients had a tumor size greater than 5 cm. Following the results of our analytical study between the relapsed group (6patients) and the non-relapsed group (21patients), there were three prognostic factors found to be significantly associated with relapse with a p value <0.05. Associated endonasal pathology (p = 0.040) increases risk of recurrence. Tumor size ≥5 cm (p = 0.005). Incomplete surgical excision (p = 0.020).
Relapse of antrochoanal polyps is often due to incomplete surgical removal and persistent inflammation. Proper identification of recurrence risk factors and the use of complete endoscopic excision with wide maxillary antrostomy are essential to reduce recurrence. Long-term follow-up is crucial for early detection and effective management.
尽管鼻窦后鼻孔息肉是非肿瘤性的且通常为单侧性，但在手术治疗后有显著的复发倾向，尤其是当息肉的鼻窦部分切除不完全时。了解与鼻窦后鼻孔息肉复发相关的机制和危险因素对于优化治疗策略和最小化复发可能性至关重要。本研究的主要目的是识别和分析与这种良性但可能复发的病理状况复发相关的预后因素。
这是一项对27例接受鼻窦后鼻孔息肉手术患者的回顾性研究。该研究在2017年1月2日至2024年7月5日的五年期间进行。在此期间接受鼻窦后鼻孔息肉手术的所有患者，无论年龄或性别，均纳入本研究。
共有21例患者在随访期间未复发。其中，14例患者（67%）接受了内镜下鼻内鼻窦切开术。然而，7例患者（33%）接受了与内镜手术相关的柯-陆氏（CWL）手术。6例患者（22.22%）出现复发。复发的平均时间为22个月，其中4例（66%）在16个月前复发。我们发现复发患者中有50%（3例）年龄在13至36岁之间，17%（1例）年龄在13岁以下，33%（2例）年龄在36岁以上。复发在性别上分布均匀，性别比为1。所有复发患者均来自城市。3例患者，即复发患者的50%，有鼻-鼻窦炎病史。所有复发患者均接受了单纯鼻内镜下中鼻道切开术以切除鼻窦后鼻孔息肉的鼻窦部分。此外，所有患者的肿瘤大小均大于5厘米。根据我们对复发组（6例患者）和未复发组（21例患者）的分析研究结果，发现有三个预后因素与复发显著相关，p值<0.05。相关的鼻内病理状况（p = 0.040）会增加复发风险。肿瘤大小≥5厘米（p = 0.005）。手术切除不完全（p = 0.020）。
鼻窦后鼻孔息肉的复发通常是由于手术切除不完全和持续炎症。正确识别复发危险因素并采用完整的内镜切除联合广泛的上颌窦开窗术对于减少复发至关重要。长期随访对于早期发现和有效管理至关重要。
