How Serious are Nasal Polyps ? ( Case Study )

Nasal polyps are inflammatory proliferative tumors arising from the mucosa of the nasal cavity and paranasal sinuses. Although many cases concerning nasal polyps have been reported, those involving external nasal deformities are rare. We report a case of nasal polyposis filling the nasal cavity and paranasal sinuses, leading to external nasal and facial deformities. The condition above is known as Woakes' syndrome, which is characterized by severe recurrent nasal polyps with deformity of the nasal pyramid, leading to broadening of the nose. 

 We performed nasal osteotomy and facial bone-shaving via the midface degloving approach, which improved the patient's facial appearance symptoms were gradually worsening. She originally presented to her local hospital with nasal obstruction and facial disfigurement secondary to extensive nasal polyps that were projecting from both nostrils. Partial polypectomy and maxillary antrostomy were conducted. On histopathological examination, the excised specimen showed inflamed mucosa consistent with nasal polyps, without features suggesting malignancy. Magnetic resonance imaging showed that the nasal cavities and paranasal sinuses were entirely filled with nasal polyps. She then underwent endoscopic sinus surgery. Although the intranasal mucosal lesions improved, the facial deformity remained, prompting referral to our department for treatment of the facial deformity. The base of her nose was enlarged, which was associated with widening of the nasal dorsum. There were also significant projections from the malar regions bilaterally. Computed tomography (CT) showed enlargement of the piriform aperture. Both medial orbital walls were extremely thin. CT showed the projection of the frontal processes of the maxilla bilaterally  Laboratory tests revealed no abnormal findings.

To improve her facial appearance, we performed rhinoplasty and nasal osteotomy via the midface degloving approach. The midface degloving approach consisted of three steps:

1) intercartilaginous, transfixion, pyriform, and nasal floor incisions were made; 

2) an extended maxillary vestibular incision was made; and

3) the midface was degloved . 

 In this way, we cut the designed lines and approached the lesion. After achieving wide exposure of the midface, we performed nasal osteotomy using an unconventional method because of the enlarged nasal cavity. We made three bilateral cuts in the nasal pyramid to narrow the nose and performed a medial nasal osteotomy. This was followed by an osteotomy in the line around where the normal nasal bone would be, so as to create a new nasal bone of normal shape and size. Finally, an osteotomy was performed in a more lateral line to shift the extra nasal bone downward. After the osteotomies, we shaped the external nose by shifting the nasal bone downward with the remaining nasal mucosa . We shaved the protuberated portion of the frontal process of the maxilla near the zygomatic bone with surgical burs to flatten and smoothen the prominent bone. Support with a bone graft or metal plate was unnecessary because the deformed nasal bone was sufficiently strong. Post¬operatively, nasal packing was inserted into both nasal cavities and an external nasal cast was applied to hold the structures in place. The postoperative course was uneventful.

At the 6-months follow-up, CT showed that the base and the dorsum of the nose had completely narrowed, whilst the height of the nose remained intact. Cheek prominence was reduced. The external nose shape improved; the patient did not experience relapse of the facial deformity.

Read more :  How to Cure Nasal Polyps Naturally at Home ?


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