Analysis of choanal polyps.

Choanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively. Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

Balanced orbital decompression combined with fat removal in Graves ophthalmopathy: do we really need to remove the third wall?

PURPOSE: To compare the reduction of proptosis and the incidence of new-onset diplopia after 3-wall (medial, lateral, and inferior) orbital decompression versus balanced medial and lateral wall decompression combined with orbital fat excision in patients with Graves ophthalmopathy. METHODS: Three-wall orbital decompression including medial, inferior, and lateral walls was performed in 13 eyes of 7 patients (group 1), and balanced medial and lateral wall decompression combined with fat removal was performed in 18 eyes of 11 patients (group 2). A transnasal endoscopic approach was used for medial wall removal. A lateral canthotomy incision combined with a short upper eyelid incision was used for extended lateral wall removal, and this was combined with an inferior conjunctival fornix incision when floor decompression was performed. RESULTS: The mean reduction of proptosis was 6.9+/-1.6 mm and 6.5+/-1.3 mm in the first and second groups, respectively; the difference was not statistically significant (P=0.37). After 3-wall decompression, 57.1% of the patients had permanent new-onset diplopia (group 1), whereas none of the patients had permanent postoperative diplopia after balanced medial and lateral wall decompression combined with fat removal (group 2). The difference in permanent new-onset postoperative diplopia between two groups was statistically significant (P<0.001). CONCLUSIONS: Balanced medial and lateral wall decompression combined with orbital fat removal provides an effective reduction in proptosis and reduces the incidence of postoperative permanent diplopia when compared with 3-wall decompression. This technique may eliminate the need for orbital floor excision.