Ossifying fibromas of the paranasal sinuses: diagnosis and management

Imaging of the Sinonasal Cavities

This article describes the various abnormalities that affect the sinonasal cavities and discusses inflammations, tumors, and tumor-like conditions. Specific imaging evaluations that focus on the sinonasal cavities are described in more detail.

Ossifying fibroma of the maxilla: A case report with literature review

Ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament cells. The lesion may progressively enlarge with the mass affecting the mandible or maxilla, resulting in facial deformities and tooth displacement despite its benign nature. Here, we presented a case of an 18-year-old female with ossifying fibroma in the maxilla extending to the maxillary sinus, infraorbital area, and skull base, resulting in considerable facial asymmetry. Since the primary treatment of ossifying fibroma is surgical resection, it is essential to determine the areas where the lesion has expanded, where a 3-dimensional computed tomography scan could play a critical role in providing such information. A complete surgical excision and histopathologic examination in treating this patient are crucial, made possible by a meticulous preoperative radio imaging technique.

Giant fronto-spheno-orbitary juvenile psammomatoid ossifying fibroma: Case report and literature review

Juvenile psammomatoid ossifying fibroma (JPOF) is an osteofibrous neoplasm that originates in the craniofacial skeleton typically during the first three decades of life. JPOFs usually involve the orbit, paranasal sinuses or the jaws. Extensive involvement of the anterior cranial base with compromised visual function is a rare phenomenon. In such clinical context, a definite diagnosis can only be made on the basis of histopathological findings, given the absence of pathognomonic radiological features. Despite being considered a benign entity, JPOFs present a locally aggressive behavior. Therefore, these neoplasms must be included in the differential diagnosis in every patient harboring a skull base osteofibrous lesion, and, once diagnosed, gross total surgical removal should be attempted. In this study, we present our experience in the diagnosis and treatment of a patient diagnosed with a giant JPOF involving the cranial base.

Ossifying fibroma of the ethmoid and sphenoid sinuses: A report of a rare case and literature review

Background

Fibro-osseous lesions include a variety of bone lesions with different clinical and histopathological features.

Case Description

We report a case of cemento-ossifying lesion involving the left ethmoid and sphenoid sinus in a 17-year-old male patient. Computed tomography showed an expansile hyperdense lesion with sclerosed peripheral mantle epicentered on the left ethmoid and sphenoid sinus and extending into the left nasal cavity. Magnetic resonance imaging was done for preoperative planning. Transnasal endoscopic resection was performed and histopathological examination confirmed the diagnosis of ossifying fibroma (OF).

Conclusion

Involvement of the ethmoid sinus with OF is a rare condition; therefore, we examined the literature for similar cases to highlight the possible clinical presentation and management. Endoscopic management is a safe, effective approach with a low rate of complications.

Malignant and Nonmalignant Sinonasal Tumors

Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article briefly reviews the classification of sinonasal tumors and provides imaging examples and imaging characteristics of each clinically important nasal and paranasal mass lesions. Although there are no true pathognomonic imaging features, it is important for the radiologist to have a broad knowledge of the various CT and MR imaging findings that can help narrow the differential diagnosis and aid in early diagnosis and mapping of tumor for treatment planning.

Single stage maxillofacial reconstruction combined radical surgery for managing juvenile ossifying fibroma: A case report

Ossifying fibroma (OF) in craniofacial is a rare disease, benign, locally aggressive fibro-osseous tumor. The 2017 World Health Organization classifications divided OF into two types: OF of odontogenic origin and juvenile ossifying fibroma (JOF). Determining the right surgical treatment to reduce the postoperative recurrence rate is incredibly challenging. The author reports two cases of paranasal sinuses with disease onset progressed from pre-pubertal age. The first case is an example of a recurrent case after undergoing conservative surgery, and the second is a new one. All cases underwent radical surgery with subtotal maxillectomy and reconstructive surgery in one stage. After observing all patients until one year, there was no sign of recurrence through clinical and endoscopic examination. There are two types of surgery that compare in this case report: conservative surgery and radical surgery. Conservative surgical procedures include curettage, enucleation, or peripheral osteotomies. Several studies have shown high recurrence levels in OF patients when curettage or enucleation is performed; residue caused by incomplete excision is the most common reason that is easily caused by conservative surgery. Radical surgery such as open maxillectomy is a promising approach for degrading the level of recurrence. JOF, especially trabecular juvenile ossifying fibroma, shows a high recurrence percentage comparing other types. The first-choice management for treating OF was the surgical approach. Types of surgery depend on the disease's aggressiveness and morbidity. Radical surgery was proven better at decreasing recurrence level than conservative surgery.

Transformation of Cemento-Ossifying Fibroma into Osteosarcoma after Radiotherapy and Nine Endoscopic Surgeries

Cemento-ossifying fibromas (COFs) are benign fibro-osseous tumors usually found in the mandible and maxilla that can show malignancy in rare situations. COFs usually grow slowly and asymptomatically until they produce local bulges, pain, headaches, and visual impairment, and have a Ki-67 index within 3%, even in aggressive and recurrent cases. Surgical resection can usually provide a satisfactory prognosis. However, no cases of COF transforming into osteosarcoma have been reported. We present a case of COF involving a 58-year-old woman whose initial symptom was hearing loss in the right ear accompanied by tinnitus. Enhanced magnetic resonance imaging revealed a 3.1 cm x 3.2 cm mass centered on the right pterygoid process of the sphenoid bone. Postoperative pathology revealed a COF with a high Ki-67 index (8%-10%). Over the next two years, the tumor relapsed repeatedly. The patient underwent nine endoscopic surgeries and radiotherapy. The sixth postoperative biopsy showed that the COF had transformed into an osteosarcoma. The patient subsequently experienced respiratory and cardiac arrests and was receiving treatment in the intensive care unit with a poor prognosis at the time of writing this manuscript. Thus, a high Ki-67 index may be a risk factor for malignant transformation for COFs.

A novel technique to repair orbital roof defects: irradiated homologous cadaveric rib (Tutoplast ®) graft in a recurrent frontal sinus ossifying fibroma

Ossifying fibroma in the fronto-ethmoidal sinuses is a rare, benign condition. In symptomatic cases, surgical excision is often undertaken and bony defects may be repaired using alloplastic grafts. We present a novel method of repairing an orbital roof defect using irradiated homologous cadaveric rib (Tutoplast ®) graft, overlaid with a pericranial flap. The patient made an excellent recovery, concluding that it is a viable and safe option with lower morbidity.

Psammomatoid ossifying fibroma in the extraconal space: a case report

A 24-year-old patient with left eye proptosis and intermittent pain for 5 months was admitted to our hospital. Physical examination revealed neither extra ocular muscle limitations nor visual field defects. Magnetic resonance imaging (MRI) revealed a multicystic mass in the left extraconal space compressing the superior oblique muscle and adjacent frontal lobe. Layered hemorrhage was observed within the lesion in the 1-month follow-up MRI. Dynamic contrast enhanced imaging showed mild increased perfusion of the surrounding peripheral portion. Magnetic resonance spectroscopy showed an increased lactate/lipid peak of 1.3 ppm. Combined open and endonasal surgery was performed, and the final diagnosis was psammomatoid ossifying fibroma. The tumor was positive for vimentin, and negative for smooth muscle actin, S100 and epithelial membrane antigen. Despite its rarity, psammomatoid ossifying fibroma should be considered when multicystic lesions with peripheral enhancement near the orbit exhibit progressive inner hemorrhage.

Pediatric Benign Fibro-Osseous Lesions of the Nose and Paranasal Sinuses: A Tertiary Hospital Experience

Background

Pediatric benign fibro-osseous lesions of the nose and paranasal sinuses are considered rare neoplastic entities. These fibro-osseous lesions are difficult to accomplish owing to the multifaceted anatomy of the skull base in addition to the closeness to neurovascular configurations.

Objective

The study aimed to study different clinical presentations, radiological manifestations, surgical management, and consequences of different benign fibro-osseous lesions in the pediatric age groups. Methods and Settings. This is a case series study of a single-center experience.

Results

Four different cases were presented and discussed (osteoma, fibrous dysplasia, and ossifying fibroma.

Conclusion

We reported four different cases of osteoma, ossifying fibroma, and fibrous dysplasia. All of these cases were managed endoscopically with no postoperative complications. Endoscopic management is considered highly effective with reduced morbidity. Preoperative radiographic studies are highly essential for diagnosis and operative planning.

Spontaneous intranasal tumours in degus (Octodon degus): 20 cases (2007-2020)

OBJECTIVE

The objective of this retrospective study was to describe the clinical and histopathological findings associated with intranasal tumours in degus.

MATERIALS AND METHODS

Medical records of degus diagnosed with intranasal neoplasms on histopathological examination between the years 2007 and 2020 at one hospital were included in the study.

RESULTS MEDICAL RECORDS OF DEGUS

Twenty degus (10 males and 10 females) were eligible for inclusion. Initial clinical signs included sneezing, abnormal nasal sounds, and nasal discharge, followed by anorexia and frequent nose rubbing. On radiography, 15 out of 20 animals showed space-occupying lesions in the nasal cavity. CT was performed in 16 animals and revealed various degrees of changes, including abnormal radiopacity within the nasal cavity and damaged nasal septum. Rhinostomy and excisional biopsy was performed in all 20 animals. Six out of 20 patients died during the perioperative period. Six and seven degus survived for 3 months and 1 year, respectively. One animal was lost to follow-up. In 16 cases the histological diagnosis was consistent with fibromas, while in 4 cases with osteomas.

CLINICAL SIGNIFICANCE

Intranasal neoplasms in degus are mostly benign mesenchymal tumours with various degrees of bone formation, which is unique to this animal species. This occurrence should be considered as an important differential diagnosis for upper respiratory tract disease in degus.

Diffuse Large B-Cell Lymphoma of the Frontal Sinus: A Case Report

Diffuse large B-cell lymphoma of the frontal sinus is a very rare malignant tumor with atypical clinical manifestations. It usually involves the orbital and ethmoid sinuses and causes vision loss, visual field damage, and nasal obstruction as the first symptoms. Herein, we report the diagnosis and treatment of a patient with diffuse large B-cell lymphoma of the frontal sinus, introduce imaging features of the disease, and discuss the differential diagnosis and treatment of the disease.

A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus

The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird’s-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.

Aggressive juvenile ossifying fibroma of the ethmoid sinus with orbital and intracranial extension: A case report

BACKGROUND

Juvenile ossifying fibroma is a rare benign destructive lesion of nose and paranasal sinuses. It occurs in the craniofacial bones of children below 15 years of age. It is usually discovered in the mandible and maxilla and rarely in the paranasal sinuses.

CASE PRESENTATION

We present a case of a 15-year-old girl with extensive right ethmoid sinus juvenile ossifying fibroma with intracranial and orbital involvement that was managed endoscopically at our center followed by lateral rhinotomy and frontal craniotomy with reconstruction due to the aggressive nature and recurrence of the disease. Patient was followed up post operatively for 3 years and was found free of symptoms ever since.

CONCLUSION

In this case report we present our experience in managing this aggressive recurrent disease of juvenile ossifying fibroma which requires multiple endoscopic and open surgical procedures. Such pathology needs a close and long follow up due to the aggressive nature of this disease.

Imaging of pediatric nasal masses: A review

Several conditions may present as nasal masses in pediatric age, including congenital and developmental disorders, inflammatory and infectious conditions, neoplastic and neoplastic-like lesions, and other miscellaneous disorders. A confident presurgical diagnosis can be challenging and imaging is often key in the management of these lesions. We provide a pictorial review of pediatric nasal masses and discuss a location-based approach to the diagnosis of these lesions on imaging studies. Acquaintance with the most common pathologies and awareness for its characteristic imaging features can aid the physician in the differential diagnosis. Location and extension of the lesion can be particularly helpful. Midline masses raise suspicion for developmental nasal midline lesions, including frontoethmoidal cephalocele, dermoid/epidermoid cyst, and neuroglial heterotopia. In case of trauma, nasal septum hematoma/abscess should be considered. Developmental or odontogenic cystic lesions and osseous neoplasms and neoplasm-like lesions can originate from the maxilla and palate. Although most nasal tumors show overlapping imaging characteristics, some have suggestive features, such as nasopharyngeal angiofibroma and esthesioneuroblastoma. Malignant tumors tend to be locally aggressive, demonstrating invasive features, bony erosion, intermediate signal on T2-weighted images, and restricted diffusion on diffusion-weighted imaging. In certain cases, a definite diagnosis can only be made histologically. Nonetheless, detailed characterization of the lesion is crucial prior to invasive procedures in order to avoid complications.

Spheno-orbital juvenile psammomatoid ossifying fibroma: a case report and literature review

Ossifying fibroma (OF) is an uncommon benign fibro-osseous lesion. Based on its clinical, morphological, and radiological features, OF is further divided into cemento-ossifying fibroma (COF), juvenile psammomatoid ossifying fibroma (JPOF), and juvenile trabecular ossifying fibroma (JTOF). JPOF rarely involves the cranial base, with limited reports published on spheno-orbital JPOF. In this paper, we report a case of JPOF of the greater wing of the sphenoid bone and lateral orbital wall in an 11-year-old child and show a surgical video. Although rare, JPOF should be considered in the differential diagnosis of fibro-osseous lesions of the spheno-orbital region.

Management and positive outcome of skull-base ossifying fibroma: a case report

The ossifying fibroma is a benign fibro-osseous tumor rarely affecting the skull base. The incidence of ossifying fibroma itself is uncommon. It is considered to be an aggressive and fast-growing bone lesion. Early detection and complete surgical removal are essential to deal with its aggressive nature and recurrence. We report a case of a 20-year-old man admitted for the management of ossifying fibroma of the orbital roof extending inside the orbit mimicking meningioma and revealed by a progressive proptosis and headache. The patient underwent surgery for the subtotal removal of the tumor with its frontal infiltration with a good outcome. All meningiomas like tumors are not meningiomas and other tumors such as ossifying fibroma might be mistaken for meningioma and even get confirmation from the pathological anatomy study. Need be for these tumors to be looked at more closely for better therapeutic decision-making.

Ossifying Fibroma in the Nasal Cavity of a 2-Year-Old Horse

Simple Summary

This article reports on the clinical features, diagnosis, and management of ossifying fibroma in the nasal cavity of a 2-year-old horse. Ossifying fibromas (OFs) are rare, benign, fibro-osseous neoplasms that occur more frequently in the rostral mandible of young horses (termed equine juvenile mandibular ossifying fibromas) but rarely in older horses. The occurrence of OF in young animals suggests developmental disorders or trauma as etiological factors. The local recurrence of OFs is common if they are not completely surgically excised, but metastatic spread is unusual. The presented case remained clinically asymptomatic until the mass obliterated the whole nasal cavity, causing severe breathing difficulties. The exact mass location was revealed using diagnostic images—namely, radiographs and computed tomography (CT) images. A concurrent problem of an underdeveloped and hypoplastic last premolar tooth of the maxilla was diagnosed. Because the mass was well-demarcated, the horse underwent standing surgery to remove the mass and the tooth. Histopathological diagnosis of ossifying fibroma was confirmed. The patient recovered uneventfully and remained free of disease at the 2-year postoperative follow-up.

Abstract

A 2-year-old mare of an unknown breed was referred to the clinic due to undetermined breathing difficulties. Physical examination revealed painless swelling rostral to the nasoincisive notch and a large, firm mass protruding from the left nostril. Radiographic examination of the head revealed a mass occupying the left nasal cavity and a displaced and hypoplastic last premolar of the left maxilla. The CT scan showed a well-demarcated heterogeneous mass measuring 22 × 9 × 5 cm (length × height × width) in the left nasal cavity attached to the roots of the displaced tooth and conchae. The surgery was performed on the standing horse. Firstly, due to the oblique position of the displaced tooth, the extraction was performed extra-orally through the trephination and repulsion of the maxillary bone. In the next step, a direct surgical approach was chosen for the caudal part of the mass via the osteotomy of the left nasal bone. The mass was bluntly separated from the conchae and removed through the nostril using Fergusson forceps. The histopathological characteristics of the mass led to the diagnosis of ossifying fibroma. The horse recovered completely in seven months, without recurrence after two years.

Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019)

OBJECTIVE

To describe the presentation, diagnosis, treatment, and outcome for horses with fibro-osseous lesions of the craniofacial complex.

STUDY DESIGN

Retrospective multicenter case series.

ANIMALS

Thirty horses evaluated for fibro-osseous lesions of the skull from January 1, 2001 through December 31, 2019 in four centers.

METHODS

Medical records were reviewed for signalment, clinical presentation, histological and diagnostic imaging findings, treatment instituted, and outcome. Long-term outcome information was obtained by owner questionnaire or the medical record.

RESULTS

Diagnoses included ossifying fibroma in 20 of 30 horses, osteoma in eight of 30 horses, and fibrous dysplasia in two of 30 horses. Twelve of 30 lesions were diagnosed in horses <1 year old, and 20 of 30 lesions originated from the rostral mandible. The most common treatment was rostral mandibulectomy. Recurrence was not reported after complete excision. Incomplete excision was confirmed in eight horses (four ossifying fibromas, three osteomas, and one fibrous dysplasia), and follow-up information was available for seven horses. Recurrence occurred in one horse, while six horses had long-term resolution of clinical signs. Prognosis for survival and return to use was excellent in 23 horses with long-term follow-up.

CONCLUSION

Fibro-osseous lesions were uncommon in this multicenter study; they were most commonly diagnosed in young animals and most frequently affected the rostral mandible. Long-term survival was excellent.

CLINICAL SIGNIFICANCE

The definitive diagnosis of fibro-osseous lesions of the craniofacial complex in horses is made from results of histopathology and cannot be determined on the basis of clinical presentation alone. Surgical excision is indicated, and prognosis can be favorable even when complete surgical margins are not obtained.

Long-Term Clinical Course of Benign Fibro-Osseous Lesions in the Paranasal Sinuses

Objectives

Fibro-osseous lesions of the paranasal sinuses can present various clinical manifestations. This study aimed to report the long-term clinical course of benign fibro-osseous lesions (BFOLs) in the paranasal sinuses, including clinical and radiologic features.

Methods

Radiologically confirmed BFOLs between 1994 and 2016, with the exclusion of osteoma cases, were retrospectively reviewed. We compared demographic characteristics between the surgery and observation groups. The reasons for the imaging study, radiographic features, histopathology, and clinical course based on serial image scans were analyzed.

Results

In total, 183 subjects were selected from a thorough review of head and neck radiologic tests (n=606,068) at a tertiary referral hospital over 22 years. Patients’ mean age was 28.6±18.1 years, and 56.3% were males. A diagnostic imaging workup was performed in 55.7% of patients due to facial asymmetry, headache, skull mass, or other symptoms related to BFOLs. In other patients (37.7%), BFOLs were found incidentally on computed tomography or magnetic resonance imaging. The most common diagnosis was fibrous dysplasia, followed by ossifying fibroma, based on both radiologic exams and histopathologic results. In total, 42.6% of the patients underwent surgery because of subjective symptoms or esthetic concerns. The patients who underwent surgery were younger (P<0.001) and had a longer follow-up duration (P<0.001) than those who underwent observation. Patients who experienced lesion growth (11.5%) were younger (P<0.001) and had more lesion sites (P=0.018) than those who did not, regardless of surgical treatment. Five patients underwent optic nerve decompression, and one patient experienced malignant transformation.

Conclusion

BFOL in the paranasal sinuses is a rare disease, and most cases were observed without specific treatment. Surgical treatment should be considered in symptomatic patients with aggressive clinical features. Regular observation and management are needed, particularly in younger patients in their teens.

Sinonasal Diseases Affecting the Orbit - A Radiological Pattern-Based Approach

The orbit is surrounded on three sides by paranasal sinuses with only a thin rim of bone separating the 2 at each site, predisposing it to the risk of being affected by the diseases of primary sinonasal compartment. A wide range of sinonasal pathologies can show orbital involvement and may present mainly with orbital symptoms. While most of these are due to contiguous involvement, a few others may be caused by systemic diseases that often involve both, the orbit and the sinuses in a noncontiguous manner. In this article, we have classified these diseases based on their radiological appearances into 5 patterns: Pattern 1 - Fat stranding predominant, Pattern 2 - Soft tissue without bone destruction, Pattern 3 - Soft tissue with bone destruction, Pattern 4 - Bony pathologies, Pattern 5 - Sinus volume changes. Various pathologies have been classified into these patterns considering the most typical changes in each of the disease processes. We briefly review these patterns, their hallmark radiological signs, typical examples of each pattern as well as review the various diseases process highlighting their radiological appearances. Imaging plays a crucial role in identifying the epicentre of the disease process, narrowing down the differential diagnoses, identifying management modifying complications, planning the surgical management as well as in the follow up of several such lesions. This unique radiological approach, although not absolute, aims to provide a new insight and working algorithm to help narrowing down the differential diagnoses.

Intranasal proliferative fibro-osseous dysplasia in a domestic longhair cat

Case summary

A 13-year-old female domestic longhair cat was presented for further investigation of chronic sneezing combined with a right-sided nasal discharge. A CT scan of the head revealed a locally invasive, aggressive right nasal mass radiographically consistent with a malignant neoplastic process. Histopathology on rhinoscopically guided biopsies revealed an unusual pathology consistent with fibro-osseous hyperplasia/dysplasia. Surgical treatment via a ventral rhinotomy and curettage was performed, and the diagnosis confirmed by repeat histopathology. The cat’s clinical signs significantly improved postoperatively.

Relevance and novel information

This case report describes an unusual feline nasal pathology. To our knowledge, there are no previous reports of a non-neoplastic, non-inflammatory expansile feline nasal tumour. Also described are the CT and histological appearance of the mass, and the difficulties encountered obtaining the definitive diagnosis. Information regarding the prognosis following surgical removal of proliferative fibro-osseous lesions in cats is poor, especially from the nasal cavity where clean margins may well be impossible to obtain. In this case, surgical resection improved clinical signs and the cat remains well at 15 months post-procedure.

Report of 3 cases of pediatric sinus osteomas with osteoblastoma-like features

Osteomas are one of the most common benign fibro-osseous lesions affecting the sinonasal tract. Rarely osteomas have osteoblastoma-like areas histologically, which are often misdiagnosed radiologically and pathologically as osteoblastomas. We report the CT and MR imaging findings of 3 cases of osteoma with osteoblastomas-like features in pediatric patients, 1 initially diagnosed as an osteoblastoma. Only 5 case reports of osteoma with osteoblastoma-like features within the paranasal sinuses have been reported in the English literature to date using the PubMed search engine, none of which include pediatric patients. We review the typical zonal imaging characteristics of this rare presentation of osteoma and propose a distinct “sclerotic cap” sign to aide radiologists in differentiating osteomas with osteoblastoma-like features from the more common benign fibro-osseous lesions. Additionally, we address some radiologic-pathologic discrepancies in diagnosis between osteoblastoma and osteoma with osteoblatoma-like features.

Giant Post-Traumatic Frontoethmoid Osteoma: Diagnostic, Therapeutic and Reconstructive Approach

Paranasal sinus osteomas are rare, slow-growing and benign lesions with potentially serious complications. They usually remain asymptomatic but when osteomas grow they can lead to local complications and cause evident aesthetic deformity due to the direct mass effect and in these situations, surgery is required. This is a report of a 30-year-old man with a rare giant post-traumatic osteoma that occupies the right nasal fossa, ethmoidal cells and frontal sinuses with extension into the right orbit.

Juvenile psammomatoid ossifying fibroma: A radiolucent lesion to suspect preoperatively

We present the cases of 2 expansive juvenile psammomatoid ossifying fibromas from sinonasal origin. Our first patient presented with a fronto-ethmoidal mass invading the orbit and the cranial base and had a bicoronal approach for tumor removal. The second patient also had orbital involvement and underwent an endoscopic surgery. Complete resection of juvenile psammomatoid ossifying fibromas is paramount to avoid recurrence, thus preoperative recognition of their characteristic thick outer mantle and radiolucent core on imaging is key, but can be challenging. We herein discuss and propose a novel algorithm of differential diagnoses of facial bone lesions based on radiologic appearance.

Unilateral visual loss resulting from orbital encroachment of an ethmoidal juvenile trabecular ossifying fibroma

Ossifying fibromas are mainly found in the mandible and maxilla. Reports of them arising in the ethmoid sinuses and orbits are rare. We present a case of an otherwise healthy 20-year-old man with gradual onset of right visual disturbance signified by right relative afferent pupillary defect due to a large unilateral ossifying fibroma arising from the ethmoid sinus compressing the medial half of the right orbit. We emphasise the multidisciplinary combined endoscopic endonasal and external approach to ensure a successful debulking of the fibroma.

Fibrous dysplasia with secondary aneurysmal bone cyst-a rare case report and literature review

INTRODUCTION

Fibrous dysplasia (FD) and aneurysmal bone cyst (ABC) are uncommon non-neoplastic intraosseous lesions, and the occurrence of concomitant FD and ABC is extremely rare.

CASE REPORT

An 11-year-old boy presented with gradual progressive enlargement of his right zygomatic bone over 4 years prior to presentation. Computed tomography revealed a lesion with a central bony area showing a ground-glass appearance surrounded by a well-defined expansile lesion with internal septations. An incisional biopsy was performed and suggested a fibro-osseous lesion. Resection was performed, followed by immediate reconstruction using autogenous bone graft from the iliac crest. Histopathological examination revealed irregularly shaped trabeculae comprising immature woven bone in a fibroblastic cell-rich stroma. Blood-filled sinusoidal spaces lined by fibrous septa containing scattered multinucleated giant cells were observed peripherally. These findings were compatible with concomitant FD and ABC. The patient was disease-free at the time of his 10-month follow-up.

CONCLUSIONS

Based on our literature search, this report is the first to describe concomitant monostotic FD and ABC in the zygomatic bone. Accurate diagnosis requires careful investigation and examination of clinical, radiographical, and histopathological features. The treatment of choice should provide an esthetic and functional improvement in the patient.

Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review

Objectives  To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities. Methods  PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines. Results  Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas ( n  = 239) and chondrosarcomas ( n  = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal ( n  = 193, 41.2%) and endoscopic extended transsphenoidal ( n  = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak ( n  = 36, 17.3%) and endocrinopathy ( n  = 43, 20.7%). Mean follow-up time was 37 months (0.5-180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up. Conclusion  Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.

A Case of Juvenile Psammomatoid Ossifying Fibroma on Skull Base

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare tumor that occurs in maxillary sinus or orbit. Complete removal is required due to the aggressive and locally destructive nature. It is hard to distinguish from psammomatoid meningioma in cranial lesion and to remove completely. The authors are presenting a case of 26-year-old male with JPOF on skull base and report this case with review of literature.

Rare case of a recurrent juvenile ossifying fibroma of the lumbosacral spine

Juvenile ossifying fibroma (JOF) is a rare benign bone tumor that occurs most frequently in the craniofacial bones of children and young adults. There are few case reports that describe its involvement outside the craniofacial skeleton, especially within the spinal column. While JOF is classified as a benign lesion, it may be locally aggressive and demonstrate a high propensity for recurrence, even after resection. Definitive surgical management may be challenging in naive cases, but it is particularly challenging in recurrent cases and when extensive spinal reconstruction is warranted. In this report, the authors describe the diagnosis and surgical management of a 29-year-old man who presented with a large recurrent sacral trabecular-subtype JOF. A review of literature regarding JOFs, management of recurrent primary spinal tumors, and sacral reconstruction are discussed.

CT and MR imaging characteristics of histological subtypes of head and neck ossifying fibroma

OBJECTIVES

The current study aimed to assess CT and MRI characteristics of histological subtypes of head and neck ossifying fibroma (OF).

METHODS

12 patients with histopathologically-proven head and neck OF were included in this study. Lesions were pathologically classified into three histological subtypes: eight cement-OFs (COFs), three juvenile psammomatoid OFs (JPOFs), and one juvenile trabecular OF (JTOF). All patients underwent CT examination, while seven also underwent MRI. Imaging characteristics were retrospectively assessed.

RESULTS

On CT images, the lesion margins were well-defined in nine patients (75%) (seven COFs and two JPOFs), partially ill-defined in two (17%) (one COF and one JTOF), and ill-defined in one (8%) (one JPOF). The continuity of the eroded overlying bone cortex was maintained in nine patients (75%) (seven COFs and two JPOFs) but disrupted in three (25%) (one COF, one JPOF, one JTOF). With respect to lesion density, homogeneous ground-glass opacity was observed in five patients (42%) (five COFs), target-like appearance in three (25%) (two COFs, one JPOF), and mixture of hyper- and hypodense areas were observed in four (33%) (one COF, two JPOFs, one JTOF). MR signal intensity was homogeneous in two patients (29%) (two COFs) and heterogeneous in five (71%) (two COFs, two JPOFs, one JTOF).

CONCLUSIONS

COFs tended to exhibit well-defined margins and preserved continuity of the overlying bone cortex. COFs were usually homogeneous, whereas JPOFs and JTOF were always heterogeneous. Target-like appearance was one of the characteristics of OFs, but it was observed in both COF and JPOF.

Imaging Sinonasal disease with MRI: Providing insight over and above CT

This article illustrates and discusses the applications and value of magnetic resonance imaging (MRI) in the evaluation of sinonasal disease. There are several clinical scenarios where MRI can add value over conventional computed tomography (CT) evaluation of the sinonasal spaces. Specifically, MRI can provide insight through better depiction of the anatomy of certain sinonasal sub-sites including the olfactory structures. It can aid in evaluating anosmia, sinusitis (fungal sinusitis and complications), benign and malignant lesions, CSF leaks and pathology extending into sinonasal spaces.

Fibro-Osseous Lesions of the Skull Base in the Pediatric Population

Fibro-osseous lesions of the skull base include a variety of lesions with different biologic behavior. The most common lesions include fibrous dysplasia, osteoma, aneurysmal bone cyst, and juvenile ossifying fibroma. The diagnosis can usually be established with radiographic imaging. In the absence of symptoms, slow-growing lesions can often be observed. When surgery is indicated for relief of symptoms, endoscopic endonasal techniques are well suited for all age groups.

Juvenile psammomatoid ossifying fibroma in paranasal sinus and skull base

CONCLUSION

The endoscopic transnasal approach with IGS is a safe and effective technique, allowing completely resection of JPOF, with minimal morbidity and recurrence.

OBJECTIVES

JPOF is a benign but locally aggressive fibro-osseous lesion. This study presents a series of JPOF cases, involving anterior skull base and orbit, treated by endoscopic transnasal approach with image guidance system (IGS) to resect the mass completely.

METHOD

This study retrospectively reviewed the clinical presentations, surgical procedures, and complications of 11 patients with JPOF who were treated by endoscopic approach from May 2009 to April 2014. All patients were followed by endoscopic and CT scan evaluations during follow-up.

RESULTS

All of the 11 cases were boys, with a mean age of 11.8 years (range = 6-17 years). The size of mass in the paranasal sinus ranged from 2.5-4.6 cm in greatest dimension (mean = 3.7 cm), and the medial orbital wall and cranial base were involved in all patients. All 11 patients received successful operation and were relieved from symptoms without mortality and major complications. During follow-up (range from 17-67 months; mean follow-up = 25.8 months), only one patient was recurrent in local position. The skull base partial resected during surgery was found to rebuild after 1 year.

Osteoma of the Middle Turbinate Presenting with Frontal Lobe Abscess and Seizure

Osteomas are the most common benign tumours of the sinonasal tract. Even though their location in the sinuses is well known, turbinate osteomas are quite rare. We report one such case of a 26-year-old female who presented with neurological complaints of a seizure rather than nasal complaints. The cause of the seizure was found to be a small abscess in her frontal lobe, secondary to frontal sinusitis due to a bony hard nasal mass arising from the middle turbinate. She underwent endoscopic excision of the mass which was confirmed on histopathology as an osteoma. The case highlights an unusual presentation of a middle turbinate osteoma.