Nasal Polyps Causing Bone Destruction and Blindness

Abstract

Although nasal polyposis is a common entity, it is seldom considered a cause of bony destruction with consequent ophthalmologic and neurologic sequelae. Acute bilateral visual loss developed suddenly in a young, healthy woman with nasal polyps. Evaluation revealed erosion of the floor of the anterior cranial fossa, with compression of the optic nerves secondary to extensive paranasal and nasal polyposis. The clinical course, treatment, and histopathologic findings are discussed.

Angiomatoid change in polyps of the nasal and paranasal regions: an underrecognized and commonly misdiagnosed lesion—report of 45 cases

“…The bone loss is usually located in the region of the lateral nasal cavity-medial maxillary sinus wall, but sometimes it can be more lateral and includes the ethmoorbital lamina papyracea [1]. There are on record cases of nasal polyps with severe destruction of the skull bones [21,22], and in one case, it caused even blindness of the patient [23]. This skeletal bone defect may further contribute to the clinical-radiologic impression of an infiltrative growth and possible malignancy.…”

Contralateral Orbital Mucocele as a Complication of Unilateral Nasal Polyposis

“…The polyposis on the left produced obstruction of mucus in the left frontal sinus, which is presumed over the course of time to have eroded the inter-sinus septum to allow extension into the right frontal sinus. Attenuation and resorption of bone may be observed in the setting of chronic sinusitis, in which chemical mediators of inflammation activate local osteoclastic activity [5][6][7].…”

Sinonasal bony changes in nasal polyposis: prevalence and relationship to disease severity

“…3 Sinonasal bone expansion, erosion and thickening secondary to nasal polyposis have all been described in the literature. 1,5,7,8,10,11 However, little has been documented regarding the prevalence of these changes and how they relate to the severity of polyposis. The results of this study showed that the total prevalence of sinonasal expansion, bony erosion and bony thickening was high (93 per cent) in this group of patients with nasal polyposis.…”

“…13 One study showed histological evidence of osteitis in more than 50 per cent of bone specimens from patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. 15 Nasal polyposis associated with sinonasal bony changes has been shown to present with symptoms such as blindness 11 or evidence of intracranial extension, 16 which may complicate surgery. Indeed, hyperostosis in patients with chronic rhinosinusitis may lead to a poorer outcome after surgery.…”

“…4 Both chronic rhinosinusitis and nasal polyposis have effects on the morphology of the nose and sinuses, such as sinonasal bone expansion, erosion and thickening. 1,[5][6][7][8][9][10][11][12] Changes are thought to be due to the mass effect of the polyps themselves and may also be secondary to chronic inflammation. 6,12 There is increasing evidence of an association between chronic rhinosinusitis and osteitis.…”