(032) An Unusual Histological Surprise Behind Choanal Atresia

Introduction: A 16-year-old adolescent male presented with complaints of unilateral nasal obstruction associated with nasal discharge since birth. Endoscopic surgical intervention revealed a oblique ledge of bone in left nasal cavity behind which was an unexpected mass of hair follicles which is an unusual site for sebaceous gland hyperplasia (SGH) as sebaceous glands and hair follicles are usually found on dorsum of nose.

Methods: A 16 year old adolescent male presented to ENT department in Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER) in October 2021, with complaints of unilateral nasal obstruction and thick nasal secretions since birth and was treated as a case of allergic rhinitis all these years with no relief. Diagnostic Nasal Endoscopy showed a fibrous band in the floor of left nasal cavity with thick tenacious secretions behind which was a bony ledge obscuring the vision of the nasopharynx. With suspicion of unilateral choanal atresia, High Resolution Computed Tomography (HRCT) of nose, paranasal sinus and orbits was done showing bony compartmentalisation of left nasal cavity extending from floor of sphenoid sinus obliquely into nasal cavity behind which was a homogenous mass on the sagittal section. Endoscopic removal of the atretic plate under General Anaesthesia revealed mixed type of atretic plate covering the posterior choana which was removed using motor drill and plasma coblation until sufficient posterior nasal aperture was created. Behind the atretic plate there was a mass of hair follicles which was removed and sent for Histopathological examination (HPE). The procedure was completed with a posterior nasal septectomy. 2 months later, we did a check nasal endoscopy which showed adequate opening of the posterior choana.

Results: The postoperative HPE was consistent with Sebaceous gland hyperplasia. Post-operatively the patient was symptom free.

Conclusions: Hair follicles in posterior part of nasal cavity is an unusual site for SGH hence we would like to report this case as a SGH choristoma in the posterior part nasal cavity which might be the first ever such reported case.