Tanta Medical Journal Vol. (36), January, 2008
Functional Endonasal Antrochoanal Polypectomy: Microscopic versus Endoscopic
Hossam M. Abdel Azeem MD, Kassem M. Kassem MD, Abou-Bakr E. Ras, MD & Ahmed El-Kady MD
Department of Otorhinolaryngology, Faculty of Medicine, Benha University
Objectives: The present study aimed to evaluate and compare the outcome of microscopic versus endoscopic antrochoanal polypectomy in patients with solitary antrochoanal polyp (ACP).
Patients & Methods: The study included 32 patients; 19 males (59.4%) and 13 females (40.6%) with mean age of 27.4±6.1; range: 16-45 years. All patients presented with a mixed spectrum of symptoms with nasal obstruction was the predominant (96.9%), snoring and oral breathing in 62.5% and 53.1%. All patients underwent history taking, full otolaryngologic examination and CT examination of the nose and paranasal sinuses. Patients were randomly allocated into two equal groups according to the procedure assigned: functional endonasal microscopic surgery (Microscopic group) or functional endonasal endoscopic surgery (Endoscopic group). The primary outcome of both procedures included the mean operative time and the extent of intraoperative bleeding evaluated as the average amount and was scored as filed visibility using Fromme scale. Surgeon satisfaction of feasibility of the technique was evaluated using a visual analog scale ranged from 0=distressing to 10= very satisfying feasibility. The frequency of immediate postoperative complications and the duration of hospital stay were also evaluated. The secondary outcome was the frequency of recurrence.
Results: The microscopic procedure provided superior primary outcome compared to endoscopic procedure manifested as significantly shorter mean operative time, (62.5 vs 73.1 minutes), less amount of intraoperative bleeding, (143.1 vs 258.8 ml) and lower score of bleeding masked field visibility (2.3 vs 3.1) and this was associated with significantly higher surgeon satisfaction score with microscopic versus endoscopic procedure (7.8 vs 6.7). Evaluation of operative time, amount of bleeding and surgical field visibility score as specific determinant for surgeon satisfaction at cutoff score of 8 using the receiver operating characteristic (ROC) curve analysis judged by the area under the curve (AUC) revealed that amount of bleeding was the specific determinant factor with AUC=0.575, followed by the operative time with AUC=0.550 and lastly the visibility score with AUC=0.350. The mean follow-up period was 22.1±6.6; range: 12-36 months with a non-significant difference between both groups; 3 cases of recurrent polyps were recorded; one in microscopic and 2 in endoscopic groups with a non-significant difference between both groups.
Conclusion: It could be concluded that for treatment of antrochoanal polyp functional endonasal surgery is appropriate with acceptable low recurrence rate; however, microscopic surgery provides shorter time of operation with minimal bleeding and less impact on field visibility thus could be advocated as the procedure of choice especially in solitary antrochoanal polyp in the hand of beginners with functional endonasal surgery.