Related Experiment Video
Updated: Nov 4, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Sinonasal polyposis complicated with extradural abscess and lateral rectus palsy
Aswin Chandran1, Harithraa Cheniappangoundar Baskar1, Anup Singh2
1ENT & Head and neck surgery, All India Institute of Medical Sciences, New Delhi, India.
Abstract:
Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.
Insights
Sinogenic intracranial complications from chronic rhinosinusitis with nasal polyposis (CRSwNP) are rare but serious. Early diagnosis and intervention are crucial to prevent severe outcomes like extradural empyema.
Area of Science:
- Otolaryngology
- Neurology
- Infectious Disease
Background:
- Sinogenic intracranial and orbital complications are infrequent but severe sequelae of chronic rhinosinusitis with nasal polyposis (CRSwNP).
- Despite antibiotic use, mortality and morbidity remain high for these complications.
- CRSwNP can lead to potentially fatal intracranial and orbital issues.
Observation:
- A case of CRSwNP presented with acute extradural empyema and sixth nerve palsy.
- Diagnosis was delayed, highlighting the challenge in recognizing these severe complications.
- The patient required early surgical intervention.
Findings:
- Delayed diagnosis and underestimation of CRSwNP can result in devastating complications.
- A high index of suspicion is necessary for early identification.
- Contrast-enhanced CT scans of the paranasal sinuses, orbit, and brain are essential for evaluation.
Implications:
- Early recognition of clinical findings and prompt radiological assessment are vital.
- Timely endoscopic intervention combined with antibiotics can lead to favorable outcomes.
- This case underscores the importance of vigilance in managing CRSwNP to prevent severe intracranial and orbital sequelae.
