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This was a patient who went on for

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surgery and had a diagnosis of sinonasal

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polyposis with associated mucoceles.

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What we notice in this case is we look into the

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nares, and what we see in the nares is soft tissue

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that's a little bit more prominent on the

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left side than the right side, but the nasal

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cavity itself up anteriorly is opacified.

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And this is pretty typical of

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a patient who has fulminant

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polyposis. The nasal cavity more

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posteriorly is also opacified.

0:35

And this would not just be secretions.

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This would be a patient who has, you know,

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polyps that are filling the nasal cavities.

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This is a patient we might

0:44

worry about cystic fibrosis.

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Check the age, see how old the patient is.

0:49

Because a young patient with this degree of

0:51

sinonasal polyposis—it's pretty striking.

0:54

You notice that the paranasal sinuses

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are completely opacified throughout.

0:59

And more importantly, we see these

1:00

areas where the bone is very thinned

1:03

at the frontal sinus communication

1:06

with the intracranial compartment.

1:09

This is actually not in the brain.

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This is actually a one air cell of

1:13

the frontal sinus where the periosteum

1:16

has just been thinned out so much.

1:18

So this is all extension of the frontal

1:21

sinus superiorly—not an epidural collection,

1:25

but in any case, you can see that there's

1:27

lots of areas of bony dehiscence.

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This is a case where I'd be very careful in looking

1:33

at my different areas of potential dehiscence.

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Remember, we worry about the

1:38

optic canal with the optic nerve.

1:40

Well, that looks okay.

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We worry about the walls of the carotid artery.

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Here's the carotid artery.

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Here's the sphenoid sinus, where at

1:47

least in this one image, I'd be concerned

1:49

about an area of dehiscence that might

1:51

be communicating with the carotid canal.

1:54

As we go further anteriorly, we have the roof

1:57

of the sphenoid sinus, which is missing.

2:00

So here we have a potential communication with

2:02

the intracranial compartment. Our maxillary

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nerve, our Vidian canal is seen here, and here.

2:07

Again, big gap in the bone that is likely still

2:12

confined by the periosteum, but is worrisome

2:16

for a potential intracranial complication.

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We look at the

2:21

lamina papyracea.

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On the left side, we see a gap here where

2:26

the lamina papyracea is missing, and you have

2:28

potential complication associated with the

2:31

superior oblique muscle just adjacent to it.

2:34

So this is another area where we

2:36

have our potential dehiscence.

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And remember, we also worry about the cribriform

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plate, and there are areas of the cribriform

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plate where I would again be concerned about

2:45

the absence of bone and the potential

2:48

for an intracranial complication.

2:50

So a good example of looking at

2:53

those areas of potential dehiscence.

2:56

Look at this lamina papyracea,

2:58

it's, you know, very thin, maybe again just defined

3:01

by the periosteum or periorbital.

3:04

So the complications of injury to the optic

3:07

nerve, injury to the carotid artery, intracranial

3:10

perforation, and perforation into the orbit

3:13

in this patient too, has fulminant sinonasal

3:16

polyposis with chronic sinusitis, as well

3:20

as mucocele formation with expansion and

3:22

thinning of the walls of the paranasal sinuses.