v因子缺乏患者鼻内息肉侵犯眼眶：诊断和手术挑战的病例报告

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-09-05 DOI:10.1016/j.ijscr.2025.111904

Ahmad Alkheder , Adel Azar , Yasser Al-Ghabra , Khaled Almooh , Aliaa Alaitouni , Ahmad Mustafa

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引用次数: 0

摘要

鼻后鼻息肉（acp）通常向后延伸至咽喉和鼻咽；轨道侵入是非常罕见的。本报告详细介绍了一例凝血功能障碍患者伴有眼眶扩张的非典型ACP，强调了诊断和手术的复杂性。病例表现：一名46岁女性，严重的因子V缺乏（0.8%），表现为2年进行性左鼻塞、鼻漏、头痛和打鼾。检查发现左鼻息肉延伸至前庭及双侧鼻甲肥大。凝血谱显示明显延长（PTT 126.8 s, INR 3.45）。CT检查发现一低密度息肉，起源于左上颌窦，经十二指肠扩张至下颌。至关重要的是，MRI证实通过骨裂侵入眶窝，T2高信号，除恶性外无钆增强。功能性内窥镜鼻窦手术（FESS）后的组织病理学显示为炎症性血管瘤性息肉，以毛细血管扩张和间质出血为特征。眼眶延伸可能是由纸莎草膜的慢性侵蚀引起的，肿块效应加剧了这种情况。血管瘤组织学（在成人中不常见）和深度凝血病增加了出血的风险。多学科管理（血液学/耳鼻喉科）指导术前因子置换和降压麻醉。角度内窥镜有助于在眶界面精确解剖，避免因凝血病变而联合入路（如Caldwell-Luc）。该病例强调了MRI在描述非典型延伸和需要量身定制的技术以确保在凝血病变中完全切除时的必要性。结论首次报道的因子v缺乏患者的ACP侵犯眼眶，说明良性息肉可能在慢性压力下侵蚀关键边界。通过先进的成像技术警惕异常延伸，结合凝血功能障碍患者的个体化手术计划，对于减轻复发和并发症至关重要。

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Orbital invasion by an antrochoanal polyp in a factor V-deficient patient: A case report of diagnostic and surgical challenges

Introduction

Antrochoanal polyps (ACPs) typically extend posteriorly into the choana and nasopharynx; orbital invasion is exceptionally rare. This report details an atypical ACP with orbital extension in a coagulopathic patient, highlighting diagnostic and surgical complexities.

Case presentation

A 46-year-old woman with severe Factor V deficiency (0.8 %) presented with 2 years of progressive left nasal obstruction, rhinorrhea, headaches, and snoring. Examination revealed a left nasal polyp extending to the vestibule and bilateral turbinate hypertrophy. Coagulation profiles showed marked prolongation (PTT 126.8 s, INR 3.45). CT imaging identified a hypodense polyp originating from the left maxillary sinus, expanding through the infundibulum into the choana. Crucially, MRI confirmed orbital fossa invasion through bony dehiscence, with T2 hyperintensity and no gadolinium enhancement excluding malignancy. Histopathology post-functional endoscopic sinus surgery (FESS) demonstrated an inflammatory, angiomatous polyp featuring telangiectatic vasculature and stromal hemorrhage.

Discussion

Orbital extension likely resulted from chronic erosion of the lamina papyracea, exacerbated by mass effect. Angiomatous histology—uncommon in adults—and profound coagulopathy amplified bleeding risks. Multidisciplinary management (hematology/ENT) guided preoperative factor replacement and hypotensive anesthesia. Angled endoscopes facilitated precise dissection at the orbital interface, avoiding combined approaches (e.g., Caldwell-Luc) due to coagulopathy. This case underscores MRI's indispensability in delineating atypical extensions and the need for tailored techniques to ensure complete resection amid coagulopathies.

Conclusion

This first reported orbital invasion by an ACP in a Factor V-deficient patient illustrates that benign polyps may erode critical boundaries under chronic pressure. Vigilance for aberrant extensions via advanced imaging, coupled with individualized surgical planning for coagulopathic patients, is essential to mitigate recurrence and complications.

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