اعوجاج الحاجز الانفي وتضخم غضاريف ‏الانف

History:

Male patient 45 years old, presented by nasal obstruction and had previous nasal operation. He complain also from headache, hyposmia, nasal discharge and facial pain. 

Examination:
Anterior nasal rhinoscopy by nasal speculum showed nasal masses on both side, pale greyish in color, insensitive to touch, arising from middle meatus and pedunculated from lateral nasal wall.
Anterior nasal endoscopy by rigid 0,30,45 degree nasal telescope showed nasal masses arising from middle meatus and superior meatus on both side of nasal cavity, most probably nasal polyposis.

  Investigation:
Radiological: CT scan axial, coronal and saggital views. Coronal cuts taked from nasal tip anterior to basisphenoid posterior. Axial cuts taked from skull base superior to the mandible inferior. CT scan bone window performed to show the details of bone. CT scan showed soft tissue density occupying the nasal cavity on both sides, opacity in anterior, posterior ethmoid, maxillary,  and sphenoid sinuses.
Accidentally, CT showed a bony lesion in posterior ethmoid sinus on right side. This bony lesion is rounded, homogenous, well defined border, no infiltration of surrounding structure like orbit or skull base. This bony lesion is most probably osteoma. The osteoma of nasal cavity most commonly occur in frontoethmoid region, and less likely to occur in posterior ethmoid as in this case. Osteoma is a benign bony tomur arising from membranous or endochondral bony origin, and of two types: compact or spongy. This case of osteoma is of compact type.
Laboratory investigation: CBC, PT, PTT, INR, Kidney and liver function.

Management:
The patient prepared for endoscopic sinus surgery. Patient take a preoperative medication, short course of systemic corticosteroid, nasal corticosteroid spray, nasal vasoconstrictor drops like otrivin.

Operation:
Endoscopic sinus surgery (ESS) with 0,30,45 nasal endoscope performed under general anaesthesia. Hypotensive technique used by anaesthesiologist through total intravenous anaesthesia (TIVA) and using local vasoconstrictor adrenaline soaked cotton pledget introduced inside middle and superior meatus. Steps of ESS are uncinectomy, middle meatal antrostomy, anterior ethmoidectomy, posterior ethmoidectomy, sphenoidotomy and frontal sinustomy. Nasal packs putted on both sides and removed after 2 days.