Background:Primary antrochoanal polyp management is commonly done via middle meatal antrostomy which has a significant risk of recurrence. The prelacrimal recess approach is reported to minimize this risk. Aim: This study aims to compare the results of prelacrimal recess approach assisted middle meatal antrostomy with middle meatal antrostomy alone in the management of primary antrochoanal polyp. Patients and methods: A randomized prospective Comparative Study was performed on sixty patients with primary antrochoanal polyps in the period from October 2020 to June 2022. The patients were allocated randomly into two groups, group (A) 30 patients were surgically managed via only endoscopic middle meatal antrostomy, and group (B) 30 patients were subjected to endoscopic prelacrimal recess approach assisted middle meatal antrostomy. Postoperative follow-up was done subjectively and objectively over 6 months. Results: Age (p=0.4), sex (p=0.6), and lesion side (p=0.8) showed no statistically significant differences between the study groups, although mean operative duration was considerably shorter in Group A (25.2 ± 3.5) than Group B (37.7 ± 4.2) (p>0.001). Regarding the complications, there was no statistically significant difference between the two study groups regarding occurrence of Nasal obstruction(p=0.3) and Synechia(p=0.1), while recurrence rate was statistically significantly higher among group A than group B (p=0.03). Conclusion: Prelacrimal recess approach assisted middle meatal antrostomy is a unique method for removing antrochoanal polyps to prevent its recurrence with reasonable operative time and few postoperative problems.