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Lee DY, Lim S, Yoon JS, Eo S. Recurred forehead osteoma disseminated after previous osteoma excision: A case report. World J Clin Cases 2023; 11:7684-7689. [DOI: 10.12998/wjcc.v11.i31.7684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Forehead osteoma is a commonly encountered benign facial bone tumor. Endoscopic excision of benign forehead masses is widely performed. Here, we report a rare case of recurrent forehead osteoma that disseminated after a previous osteoma excision.
CASE SUMMARY A 54-year-old female patient had previously undergone endoscopic removal of a single forehead osteoma at 30 years of age. However, she had a recurrent osteoma around the same site and underwent another endoscopic resection at 40 years of age. During her first visit to our outpatient clinic, she presented with a cobblestone-like irregular surface on the forehead and a 3D facial bone computed tomography scan revealed a widely ragged surface of the inoculated osteoma on the outer table of the frontal bone. Under general anesthesia, we performed a radical complete excision of the disseminated osteoma through a bicoronal incision using an osteotome, chisel, mallet, and rasping. We hypothesized that the recurrence may have been caused by the inoculation of residual osteoma remnants from the previous procedure. Craniofacial surgeons should be cautious when removing osteoma particles, particularly when using an endoscopic approach.
CONCLUSION To prevent recurrence, it is essential to conduct additional meticulous burring and a thorough inspection of the surface after copious irrigation.
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Affiliation(s)
- Dong Yun Lee
- Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
| | - SooA Lim
- Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
| | - Jung Soo Yoon
- Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
| | - SuRak Eo
- Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
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Sofokleous V, Maragoudakis P, Kyrodimos E, Giotakis E. Management of paranasal sinus osteomas: A comprehensive narrative review of the literature and an up-to-date grading system. Am J Otolaryngol 2021; 42:102644. [PMID: 33799138 DOI: 10.1016/j.amjoto.2020.102644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgical excision represents the unequivocal treatment modality for symptomatic paranasal sinus osteomas. However, the optimal surgical approach and the extent of the surgery, as well as the management stance in the case of an asymptomatic tumor, remain controversial. METHODS The MeSH terms 'Osteoma', 'Nasal Cavity', and 'Paranasal Sinuses' were used to retrieve articles concerning the management of paranasal sinus osteomas that were published in the last 30 years, the vast majority of which comprised case reports of one or two cases. Original articles or large series of more than six cases were prioritized. RESULTS Our review summarizes previous findings and opinions relevant to the management of symptomatic and asymptomatic paranasal sinus osteomas. The recent shifts in trends of their management are thoroughly discussed. Currently, an extension of the lesion through the anterior frontal sinus wall; an erosion of the posterior wall of the frontal sinus; a far-anterior intraorbital extension; an attachment to the orbital roof beyond the midorbital point; and some patient-specific adverse anatomic variations that may restrict access, are considered strong contraindications to a purely endoscopic approach. On the grounds of this thorough review, a new grading system for frontal and frontoethmoidal osteomas is proposed to allow better conformity to recent advancements and current clinical, research, and educational needs. CONCLUSION Over the past 30 years, endoscopic techniques have emerged as the new standard of care for favorably located paranasal sinus osteomas. Nonetheless, open approaches remain indispensable for the management of the more perplexing cases of frontal sinus osteomas.
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Giotakis E, Sofokleous V, Delides A, Razou A, Pallis G, Karakasi A, Maragoudakis P. Gigantic paranasal sinuses osteomas: clinical features, management considerations, and long-term outcomes. Eur Arch Otorhinolaryngol 2020; 278:1429-1441. [PMID: 33064177 DOI: 10.1007/s00405-020-06420-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Paranasal sinus osteomas are slow-growing, benign bony tumours that when larger than 30 mm, they are termed 'gigantic'. Special considerations apply for tumours of this calibre, and their rarity renders their management fairly controversial. This study seeks to contribute to an increased understanding concerning their management by presenting a 12-year experience from a single institution. METHODS Retrospective review of files of patients treated for a gigantic paranasal sinus osteoma from January 2008 to December 2019. Additionally, all patients were prospectively reexamined in early 2020 for late complications or clinical recurrence. RESULTS Ten patients were included, with a mean age of 53.8 years (range: 23-77 years). The leading presenting findings were proptosis (80%) and diplopia (70%). Transient visual impairment was remarkably frequent (30%). Five patients were managed with an open approach, two with an endoscopic, and three with a combined technique. The most common adverse characteristics that dictated the use of an open approach, alone or in combination with an endoscopic approach, were the involvement of the anterior wall of the frontal sinus (40%), erosion of its posterior wall (30%), and a far-anterior intraorbital extension (30%). No major postoperative complications were observed, and also no recurrences. CONCLUSION Our study illustrates that these tumours may require a different management attitude. Despite substantial advances in the endoscopic management of benign sinonasal tumours, managing these massive tumours solely endoscopically could, in many cases, be inefficacious or impossible. Open approaches remain valuable, representing a safe and straightforward method for adequate exposure.
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Affiliation(s)
- Evangelos Giotakis
- Department of Otorhinolaryngology - Head and Neck Surgery, General Hospital of Athens "Hippokration", National and Kapodistrian University of Athens, Athens, Greece
| | - Valentinos Sofokleous
- Department of Otorhinolaryngology - Head and Neck Surgery, General Hospital of Athens "Hippokration", National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexander Delides
- Department of Otorhinolaryngology - Head and Neck Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andriana Razou
- Department of Otorhinolaryngology - Head and Neck Surgery, General Hospital of Athens "Hippokration", National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Pallis
- Department of Otorhinolaryngology - Head and Neck Surgery, General Hospital of Athens "Hippokration", National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Karakasi
- Department of Otorhinolaryngology - Head and Neck Surgery, General Hospital of Athens "Hippokration", National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Maragoudakis
- Department of Otorhinolaryngology - Head and Neck Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kim M, Otten M, Kazim M, Gudis DA. Frontal osteoplastic flap without frontal sinus obliteration for orbital roof decompression. Orbit 2020; 40:145-149. [PMID: 32340509 DOI: 10.1080/01676830.2020.1757126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: We describe a novel surgical approach for bilateral orbital roof decompression using a frontal osteoplastic flap without frontal sinus obliteration. This technique utilizes a combined external and endonasal endoscopic approach for wide exposure to the orbital roof bilaterally. We demonstrate this technique for the resection of a massive frontal fibrous dysplasia lesion in a healthy male with bilateral orbital roof involvement. The endonasal endoscopic portion of the technique includes a Draf III frontal sinusotomy (endoscopic modified Lothrop procedure) which precludes the need for frontal sinus obliteration, restores normal frontal sinus function, and allows for postoperative endoscopic surveillance. Methods: Report of novel surgical technique with video demonstration. Results: This technique for orbital roof decompression allows for removal of a frontal lesion, wide decompression of the bilateral orbital roof, and post-operative endonasal endoscopic surveillance of the cavity. The patient in whom we demonstrate this technique had complete resolution of his orbital symptoms and minimal residual fibrous dysplasia postoperatively. Conclusion: Bilateral orbital roof decompression for frontal lesions can be performed safely and effectively with a frontal osteoplastic flap without frontal sinus obliteration, restoring normal orbital and sinus function.
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Affiliation(s)
- Matthew Kim
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - Marc Otten
- Department of Neurological Surgery, The Neurological Institute of New York, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - Michael Kazim
- Oculoplastic and Orbital Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - David A Gudis
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
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Chahed H, Hachicha H, Bachraoui R, Marrakchi J, Mediouni A, Zainine R, Ben Amor M, Beltaief N, Besbes G. Paranasal sinus osteomas: Diagnosis and treatment. ACTA ACUST UNITED AC 2016; 117:306-310. [PMID: 27496644 DOI: 10.1016/j.revsto.2016.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/22/2016] [Accepted: 04/29/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Osteoma is the most common benign tumor of the nose and paranasal sinuses. It is a slow-growing bony tumor, often asymptomatic, occurring mainly in frontal and ethmoid sinuses. Theories regarding the origin of osteomas are still discussed. The aims of the study were to describe diagnosis circumstances in our series and to set out our respective indications for open and endoscopic approaches in the treatment of nasosinusal osteomas. PATIENTS AND METHODS A retrospective study was conducted on the files of all the patients treated for a paranasal sinus osteoma in our department between 1990 and 2013. Diagnosis circumstances and kind of treatment were collected and analyzed. RESULTS The files of 45 patients (mean age: 49.2; sex-ratio: 1.19) could be collected. The most common symptom was headache found in all patients. The most common location was the frontal sinus (30 cases). Thirty-nine open procedures were performed. Four osteomas were removed under endoscopic assistance. In one case, a combined approach has been used. Overall complication rate was 11.1%. Symptoms improved in all patients. Two recurrences were observed. DISCUSSION Surgical indications in paranasal sinus osteomas are theorically well codified. However, approaches remain controversial. In our experience, the preferred approach was the open one. Endoscopic techniques, when indicated, are more challenging and need sophisticated instrumentation and a long learning curve.
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Affiliation(s)
- H Chahed
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia.
| | - H Hachicha
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - R Bachraoui
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - J Marrakchi
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - A Mediouni
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - R Zainine
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - M Ben Amor
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - N Beltaief
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
| | - G Besbes
- Department of ear, nose and otorhinolaryngology and cervicofacial surgery of Rabta hospital, Jebel Lakhdar Bab Saadoune, 1007 Tunis, Tunisia
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Kim JS, Lee JH, Kim NG, Lee KS. Forehead Osteoma Excision by Anterior Hairline Incision with Subcutaneous Dissection. Arch Craniofac Surg 2016; 17:39-42. [PMID: 28913252 PMCID: PMC5556722 DOI: 10.7181/acfs.2016.17.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/10/2015] [Accepted: 01/26/2016] [Indexed: 11/17/2022] Open
Abstract
Forehead osteomas are benign but can pose aesthetic and functional problems. These osteomas are resected via bicoronal or endoscopic approach. However, large osteomas cannot be removed via endoscopic approach, and bicoronal approach can result in damage to the supraorbital nerve with resultant numbness in the forehead. We present a new approach to resection of forehead osteomas, with access provided by an anterior hairline incision and subcutaneous dissection. Three patients underwent resection of the forehead osteoma through an anterior hairline incision. The dissection was carried in the subcutaneous plane, and the frontalis muscle and periosteum were divided parallel to the course of supraorbital nerve. The resulting bony defect was re-contoured using Medpor®. All three patients recovered without any postoperative infection or complication and symptoms. Scalp sensory was preserved. Aesthetic outcomes were satisfactory. Patients remain free of recurrence for 12 months of follow up. The anterior hair line approach with subcutaneous dissection is an effective method for removal of forehead osteoma, since it offers broad visualization and hides the scar in the hairline. In addition, the dissection in the subcutaneous plane avoids inadvertent injury to the deep nerve branches and helps to maintains scalp sensation.
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Affiliation(s)
- Jun Sik Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong Hwan Lee
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nam Gyun Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung Suk Lee
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Turan Ş, Kaya E, Pınarbaşlı MÖ, Çaklı H. The Analysis of Patients Operated for Frontal Sinus Osteomas. Turk Arch Otorhinolaryngol 2015; 53:144-149. [PMID: 29391998 DOI: 10.5152/tao.2015.1149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/31/2015] [Indexed: 11/22/2022] Open
Abstract
Objective Paranasal sinus osteomas are benign tumors that are smooth-walled, slow-growing, and induced by bone tissue. Although their most common localization is the frontal sinus, some osteomas are seen in the ethmoid, maxillary, and sphenoid sinuses. Frontal sinus osteomas are often asymptomatic; however, when they become symptomatic, headache is the most common complaint. In this study, we aimed to analyze the postoperative results of patients who were diagnosed with frontal sinus osteoma and were operated with appropriate surgical techniques. Methods We retrospectively evaluated 14 patients who were diagnosed with frontal sinus osteoma and were operated in our department between March 2009 and July 2014. The following parameters were analyzed: patients' age and gender, complaints at the time of admission to our clinic, pathological findings from physically examination, tumor features observed in preoperative paranasal sinus computed tomography (size and localization), surgical methods applied, intra- and postoperative complications, and recurrence rates. All patients preoperatively provided informed consent. Results Of the 14 patients, 7 were males and 7 were females, with a mean age of 40.57 years. A total of 11 (79%) osteomas were located within the frontal sinus and 3 (21%) within the frontal recess. External surgical approach was performed to 11 patients, endoscopic approach was performed to 2 patients and external and endoscopic approach was performed to 1 patient together. Conclusion Although the preferred surgical method in frontal sinus osteoma depends depended on size and localization of tumors, experience of surgeon is also important. Although the external surgical approach is appropriate for large and laterally localized osteomas, the endoscopic approach is appropriate for small and inferomedially localized osteomas. In both surgical approaches the site of origin should be drilled.
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Affiliation(s)
- Şükrü Turan
- Department of Otorhinolaryngology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ercan Kaya
- Department of Otorhinolaryngology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Mehmet Özgür Pınarbaşlı
- Department of Otorhinolaryngology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Hamdi Çaklı
- Department of Otorhinolaryngology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
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Grusha YO, Fedorov AA, Ismailova DS, Prause JU. [Rare case of primary orbital osteoma]. Vestn Oftalmol 2015; 131:76-81. [PMID: 26977730 DOI: 10.17116/oftalma2015131676-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of primary orbital osteoma originated from the sphenoid and notable for a mismatch between its giant size and mild clinical presentation. A lot of attention has been paid to the choice of surgical technique.
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Affiliation(s)
- Y O Grusha
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, 2-4 Bol'shaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - A A Fedorov
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021
| | - D S Ismailova
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, 2-4 Bol'shaya Pirogovskaya St., Moscow, Russian Federation, 119991
| | - J U Prause
- Eye Pathology Institute, University of Copenhagen, INF - Frederik V's Vej 11, 2100, Copenhagen, Denmark
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Affiliation(s)
- S.B. Mali
- Oral and Maxillofacial Surgery; CSMSS Dental College Aurangabad; Aurangabad India
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10
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Cheng KJ, Wang SQ, Lin L. Giant osteomas of the ethmoid and frontal sinuses: Clinical characteristics and review of the literature. Oncol Lett 2013; 5:1724-1730. [PMID: 23759920 PMCID: PMC3678544 DOI: 10.3892/ol.2013.1239] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/20/2013] [Indexed: 11/08/2022] Open
Abstract
Giant osteomas of the ethmoid and frontal sinuses ary very rare, with only a few dozen cases reported in the literature. Given their rarity, the clinical characteristics and treatment of this disease remain controversial. In this study, the clinical presentation and surgical methods used to treat three patients with giant osteomas of the ethmoid and frontal sinuses are described, combined with a review of the literature from 1975 to 2011. In total, 45 patients with giant osteomas arising from the ethmoid and frontal sinuses (including the present cases) have been reported in 41 articles. Headache and ocular signs are the most common symptoms. This disease often leads to intracranial or intraorbital complications. The main treatment for giant osteoma is surgery via an external approach. The outcome of surgery for giant osteoma is good, with rare recurrence, no malignant transformation and few persistent symptoms.
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Affiliation(s)
- Ke-Jia Cheng
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Pagella F, Pusateri A, Matti E, Emanuelli E. Transnasal endoscopic approach to symptomatic sinonasal osteomas. Am J Rhinol Allergy 2012; 26:335-9. [PMID: 22801023 DOI: 10.2500/ajra.2012.26.3782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND One of the most challenging benign tumors for the ear, nose, and throat (ENT) surgeon is represented by sinonasal osteomas. Surgical treatment should regard just symptomatic osteomas, because these tumors can provoke rhinosinusitis and mucoceles. Recently, new instruments have been applied in endoscopic sinus surgery (ESS). This study was designed to present our experience in the endoscopic management of osteomas of the paranasal sinuses. Clinical findings, preoperative imaging strategy, and surgical techniques are discussed. METHODS We retrospectively reviewed clinical records of patients who underwent ESS for sinonasal osteomas between 2003 and 2010 in our institutions. RESULTS We have treated with a transnasal endoscopic approach 29 patients affected by paranasal osteomas (13 men and 16 women; age range, 20-78 years; mean, 49.5 years). We found frontoethmoidal junction localization in 14 patients, frontal sinus in 6 patients, ethmoid in 6 patients, sphenoid in 1 patient, maxillary in 1 patient, and multiple osteomas in 1 patient. Initially, patients were treated by the cavitation technique with standard ESS instruments, whereas in more recent cases surgery was assisted by the use of ENT navigation system, curved drills, and ultrasound bone emulsifier. No major complications occurred. No radiological or endoscopic signs of recurrence (mean follow-up, 52 months; range, 6-89 months) have been observed. CONCLUSION Endoscopic removal of osteomas of the sinonasal region is feasible, taking into account the location and size of the lesion. Particular importance should be given to new instruments that have been applied in the last years in ESS.
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Affiliation(s)
- Fabio Pagella
- Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Adeleye AO. A giant, complex fronto-ethmoidal ivory osteoma: Surgical technique in a resource-limited practice. Surg Neurol Int 2010; 1:97. [PMID: 21245944 PMCID: PMC3019364 DOI: 10.4103/2152-7806.74489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 11/01/2010] [Indexed: 11/12/2022] Open
Abstract
Background: Unlike small and medium size fronto-ethmoidal osteomas which are amenable to surgical excision through limited craniofacial openings, giant lesions require extensive and complex craniofacial dissection, and post lesionectomy reconstruction using an array of modern-day surgical adjuncts. This is a report of our surgical technique for the successful and esthetically fair operative resection of a giant fronto-ethmoidal osteoma in a difficult practice setting. Case Description: A 32-year-old Nigerian lady harbored a giant complex fronto-ethmoidal ivory osteoma. Deploying our understanding of modern-day advanced microsurgical anatomy and technique of skull base surgery, but under severe resource limitations, a radical total surgical resection was performed and an esthetically fair post lesionectomy reconstruction was achieved. The patient remains tumor-free in 20 months, so far, of postoperative follow-up. Conclusions: Even under severe resource limitations, inventive adaptations of modern-day skull base surgery techniques can facilitate hitherto unusual functional and esthetically successful resection of giant osteomas of the fronto-ethmoidal sinus complex.
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Affiliation(s)
- Amos Olufemi Adeleye
- Skull Base Surgery Unit, Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
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13
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Abstract
Maxillofacial district osteomas are benign lesions with very slow growth. The most frequent localization is the frontal sinus, about 57% of all paranasal cavity osteomas; less frequently, they can be located in the ethmoidal sinus or sphenoidal and maxillary. Etiology has not completely clarified yet; nevertheless, there are 3 main pathogenetic theories: osteogenic, traumatic, and infective. Open procedures represent the gold standard, but there is still an unsolved debate for the best treatment option. Endoscopic techniques offer an alternative approach, enabling closer and more direct visualization of the anatomy as well as avoiding damage to surrounding structures. In our study, we analyzed all patients treated with endoscopic approach for paranasal sinus osteomas in the ENT unit of the University of Varese and compared them with patients treated for the same pathology with open surgery in the Maxillo-facial Department of the University of Rome "La Sapienza." The purpose of the work was to compare the advantages and disadvantages of the 2 procedures. In conclusion, this study underlines the importance of flexibility in surgical approach decision, which must fit the different issues of the pathology and of the patient.
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Secer HI, Gonul E, Izci Y. Surgical management and outcome of large orbitocranial osteomas. J Neurosurg 2008; 109:472-7. [DOI: 10.3171/jns/2008/109/9/0472] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study is to review the surgical management and outcome of patients who were treated for large orbitocranial osteomas at Gulhane Military Medical Academy over a period of 7 years.
Methods
Twenty-one patients with large orbitocranial osteomas were evaluated retrospectively. All patients were male and between 19 and 25 years old. Surgery was performed in all patients. The main surgical procedure was resection of the osteoma using orbitotomy and/or craniotomy followed by orbital reconstruction and cranioplasty. Cranioplasty was performed in 16 patients, using methyl methacrylate in 5 patients (31%) and porous polyethylene in 11 patients (69%). Thin, flexible, porous polyethylene was preferred for orbital reconstruction in 10 patients. The cranioplasty materials were attached to the intact bone using miniplates.
Results
There were no severe postoperative complications. Mild transient periorbital ecchymosis was noted in 19 patients. The mean follow-up period was 11.7 months (range 9–24 months) after surgery. No tumor regrowth was observed in any patient at the end of the follow-up period.
Conclusions
Large osteomas of the orbitocranial region must be resected for cosmetic and functional reasons. Selection and planning of the surgical technique should be based on the direction of the tumor growth and on the size of the tumor and the structures that are compressed by the tumor.
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The bicoronal approach for the treatment of a large frontal sinus osteoma. A technical note. Am J Otolaryngol 2007; 28:427-9. [PMID: 17980778 DOI: 10.1016/j.amjoto.2006.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 10/27/2006] [Accepted: 10/31/2006] [Indexed: 11/20/2022]
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Karapantzos I, Detorakis ET, Drakonaki EE, Ganasouli DL, Danielides V, Kozobolis VP. Ethmoidal osteoma with intraorbital extension: excision through a transcutaneous paranasal incision. ACTA ACUST UNITED AC 2005; 83:392-4. [PMID: 15948797 DOI: 10.1111/j.1600-0420.2005.00459.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe a case of conjunctival hyperaemia and proptosis of the right eye. METHODS Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach. RESULTS The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively. DISCUSSION Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures.
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Affiliation(s)
- Ilias Karapantzos
- Department of Ear, Nose and Throat Diseases, University Hospital of Alexandroupolis, Thrace, Greece
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El Kohen A, Lahlou M, Rabeh G, Benjelloun A, Lazrak A, Jazouli N, Kzadri M. [Orbital osteoma: clinical evaluation of nine cases]. ACTA ACUST UNITED AC 2005; 106:7-12. [PMID: 15798645 DOI: 10.1016/s0035-1768(05)85793-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Osteoma of the nasosinus cavities, particularly the frontoethmoidal cavities, is often a fortuitous radiographic discovery. Potential complications include ophthalmological, sinusal, and endocranial disorders. MATERIAL AND METHODS Nine patients (five men and four women), mean age 24.3 years (18-43) presenting orbital osteoma were managed from 1994 to 1999. RESULTS Clinical signs were dominated by ophthalmological disorders, basically non-reducible exophthalmia (n = 8). Two patients had permanent unilateral nasal obstruction and one had acute sinusitis. The bony orbital tumefaction was located in the superior medial angle in five patients. Radiography (Blondeau view) demonstrated an opacity in the sinus with an orbital extension. Computed tomography, performed in all patients, identified the lesion location: ethmoidofrontal (n = 4), anterior ethmoidal (n = 2), frontal (n = 2), ethmoidomaxillary (n = 1). There were no endocranial extensions. Surgery was undertaken for eight patients generally via the transfacial approach (n = 7); a bicoronal approach was used for one patient. En bloc resection (n = 4) or fragmentation (n = 4) was performed. There was one postoperative complication: regressive diplopy. These patients have been followed regularly with clinical and radiographic explorations and have been free of relapse for 2 to 6 years. DISCUSSION Frontoethmoidal osteoma is a relatively rare benign tumor. Severity depends on the orbital and endocranial extension. Imaging provides the positive diagnosis and guides the surgical approach. Therapeutic indications depend on the tumor size, its course, and the development of complications. We observed total relapse free outcome after complete resection.
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Affiliation(s)
- A El Kohen
- Service d'ORL et de Chirurgie Maxillo-Faciale, Hôpital des Spécialités, CHU Avicenne, Rabat, Maroc.
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Fobe LPDO, Melo ECD, Cannone LF, Fobe JL. [Surgery of frontal sinus osteoma]. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:101-5. [PMID: 11965417 DOI: 10.1590/s0004-282x2002000100018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Frontal sinus osteomas are 57% of all paranasal sinus osteomas, with an incidence of 00.1 to 3%. Surgical removal of the frontal sinus osteomas is done in symptomatic patients. Asymptomatic patients can be managed conservatively or submitted to surgery in spite of its location or extension. Five patients having the diagnosis of frontal sinus osteoma were operated on between 1995 and 1999. Medium age was 38.4 years (from 12 to 55 years), 3 male and 2 female. Symptoms occurred from 6 months to 3 years, average of 10.5 months. Four patients had previous headache and one had epistaxis. All patients had standard radiological exams and computed tomography with coronal and axial studies of paranasal sinus. In two patients the diameter of the osteoma was larger than 3 cm and in three smaller than 3 cm. The choice between coronal and supraciliar approach was made according to esthetics, supraciliar approach was made in only one bald patient even with the tumor being large and extending to ethmoidal sinus. Any intra operative difficulty was related to the choice of the approach. Naso-frontal ostium was not obstructed in intra operative course. Minimal postoperative follow up was of two years. Osteomas were radically removed in all patients with no recurrence or residual tumor. Clinical findings, radiological exams and surgical approaches are discussed. No postoperative complications occurred.
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Pressman P, Allen GW. Maxillary sinus mass: The case for the unerupted third molar. Otolaryngol Head Neck Surg 2000. [DOI: 10.1067/mhn.2000.98911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Affiliation(s)
- P Pressman
- Northwestern University Medical School, Chicago, Illinois, USA
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Affiliation(s)
- R H Vowles
- Department of Otolaryngology-Head and Neck Surgery, Wexham Park Hospital, Slough, England
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