Single-port Endoscopic Removal of Forehead Osteoma: An Otolaryngologist's Procedure

For otolaryngologists, single-port endoscopic removal of forehead osteoma draws upon a familiar skill set and is a robust technique for complete tumor removal with excellent cosmesis. Laryngoscope, 134:2194-2197, 2024.

A rare case of Gardner syndrome in an African adult male: A case report

Gardner's syndrome with the complete manifestation of colonic and extracolonic features is uncommon. Therefore, every clinician should view extracolonic features with a high index of suspicion. This may be key to early diagnosis, definitive management in these patients and importantly, helps prevent malignant transformation of existing colonic polyps.

Surgical Proposition of a Slow-Growing Calvarial Exostosis in a Female Patient With a Congenital Iris Cyst of the Anterior Chamber and Mandibular Tori

We present an unusual case of a woman in her early 50s with a slow-growing calvarial exostosis. Exostoses are bony spurs or osteomas extending outward beyond a bone's surface and may be benign or malignant. Calvarial exostoses are a less common bone tumor that can occur in the population. We present a case of a rare, slow-growing calvarial exostosis with a combination of mandibular tori and a congenital iris cyst. We discuss differentials of this exostosis and different syndromes that may cause it such as hereditary multiple exostoses and Gardner syndrome. The current article aims to spread awareness of this atypical presentation of exostoses and present our institution's surgical proposition for removing a calvarial exostosis to obtain a further histological analysis of its composition. As these masses may commonly be benign, a definitive diagnosis cannot be made through imaging alone to rule out more threatening conditions. We have addressed radiological findings and diagnostic and treatment options offered to the patient. The patient decided not to move forward with removing the mass and would continue to monitor and return should she notice any unusual or acute changes.

Management of frontoethmoidal osteoma causing pneumocephalus and cerebrospinal fluid leakage with minimally invasive techniques: illustrative cases

BACKGROUND

Osteoid osteoma is a common benign bone tumor frequently seen in the frontoethmoid region. However, involvement of the skull base is rare, with few cases previously reported.

OBSERVATIONS

The authors report two cases of spontaneous, symptomatic frontoethmoidal osteoma: one presented with neurological deficit secondary to tension pneumocephalus and the other with cerebrospinal fluid leakage. The first case was managed with a transfrontal sinus craniotomy and pneumocephalus decompression with osteoma resection and skull base reconstruction. The second case was managed with a uninaral endoscopic endonasal approach to the anterior skull base with osteoma resection and reconstruction.

LESSONS

Given the paucity of cases with associated tension pneumocephalus described in the literature, it was relevant to describe the authors' experience with surgical decision-making and the expected outcomes among patients with this pathology when using minimally invasive techniques.

Trigeminal neuralgia secondary to osteoma and vascular compression: illustrative case

BACKGROUND

Trigeminal neuralgia (TN) is a common neurosurgical issue that has a detrimental impact on patients' quality of life. Osteoma at the petrous apex is a rare etiology of TN. Here, the authors present a case involving the co-occurrence of petrous osteoma and a vascular loop around the trigeminal nerve. Both exerted pressure or compression on the exit of the trigeminal nerve.

OBSERVATIONS

A 46-year-old male presented with a 3-year history of persistent severe pain in the right side of his face. Magnetic resonance tomographic angiography of the trigeminal nerve revealed an abnormal signal in the right prepontine cistern, along with a vascular loop accompanying the right trigeminal nerve. A computed tomography scan of the skull indicated a nodular calcified density. The combined anterior transpetrosal approach for petrous osteoma and microvascular decompression (MVD) for the offending vessel were successfully performed. The patient was discharged without any complications or facial pain.

LESSONS

Although extremely rare, TN simultaneously secondary to petrous osteoma and offending vessels should be considered in the diagnosis. In this case, the combined surgical removal of petrous osteoma and MVD for the offending vessels proved to be an effective treatment for TN secondary to osteoma and vascular compression.

Surgical Approach to Frontal and Ethmoid Sinus Osteomas: The Experience of 2 Metropolitan Italian Hospitals

OBJECTIVES

The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian hospitals between 2012 and 2019.

METHODS

A retrospective chart review of cases of frontal and ethmoid osteomas from the Ca' Granda Niguarda Hospital of Milan and the Policlinico Umberto I University Hospital of Rome was performed. All patients underwent preoperative computed tomography and, when orbital or intracranial extension was suspected, magnetic resonance imaging. Surgical treatment was performed according to Chiu classification.

RESULTS

A total of 38 cases of frontal and ethmoid sinus osteomas were included in the study; 22 patients were men and 16 were women. The mean age at diagnosis was 49 years. Seven (18.4%) patients were treated using an open approach; 3 (7.9%) patients underwent open and endoscopic approach; the remaining 28 (73.7%) patients were treated with endoscopic approach. Seven (18.4%) patients had a cerebrospinal fluid leak intraoperatively and were treated with the placement of tissue graft through the defect. The mean follow-up time was 18 months; no recurrence was observed at 12-month follow-up.

CONCLUSION

Osteomas of the frontal and ethmoid sinuses can be treated using different techniques, mostly endoscopically. The choice of surgical approach (endoscopic vs open) depends on the location and size of the osteoma, anatomical size, characteristic of the sinus, surgeon's experience, and available existing technical facilities. Cerebrospinal fluid leak is a possible complication of surgery.

Management of Giant Frontoethmoid Osteoma by Combined Approach

Giant osteomas of the frontoethmoidal region often manifest early with ocular symptoms and intracranial complications. The management involves careful surgical planning of both the approach and reconstruction. In the present case report, a case of giant frontoethmoid osteoma presented with ocular symptoms and cosmetic deformity. The case was managed by a combined endoscopic and open surgical approach along with reconstruction of the sinus wall defect using a pericranial flap and titanium mesh. The outcome was found to be satisfactory with the resolution of ocular symptoms and good cosmesis.

Paranasal Osteoma: The Importance of Surveillance

Paranasal osteomas are rare benign bone tumours originating within the paranasal sinuses. Despite their benign nature, these slow-growing osseous lesions can lead to a spectrum of symptoms ranging from asymptomatic discovery to nasal obstruction, headache, facial deformity, and ophthalmological complications. We present the case of a 52-year-old female who initially presented with chronic sinusitis-like symptoms in 2008 and was incidentally found to have a small right-sided paranasal sinus osteoma on CT. Eleven years later, in 2019, she re-presented with new symptoms of unilateral nasal obstruction, epiphora, and restriction in her lateral gaze and was diagnosed with a large osteoma causing structural and ophthalmological issues (proptosis and epiphora). Endoscopic removal of the osteoma successfully alleviated her symptoms. This case emphasises the importance of surveillance of paranasal osteomas as there are no formal guidelines to support clinicians, as even though they grow slowly, they can eventually lead to significant "mass-effect" symptoms and impact local structures. Thus, monitoring and consideration of surgical intervention are crucial to managing these lesions effectively.

Primary Benign Neoplasms of the Spine

Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.

A Report of Two Simultaneous Different Skull Vault Boney Pathologies: An Extremely Rare Clinical Scenario

Primary calvarial boney tumors are generally rare in clinical practice. Multiple primary skull neoplasms are less frequent, typically associated with genetic disorders or familial syndromes. Sporadic cases of multiple skull tumors are exceptionally rare. We present a unique scenario of a 32-year-old female patient who had two right-sided skull vault lesions, one located over the right parietal area and the other in the right retro-auricular region. The lesions exhibited different behaviors over several years. The workup revealed that the two skull lesions were of two pathologies. The standard academic approach for clinical analysis attributes the symptoms often to one pathological process until proven otherwise. This case highlights the significance of expanding the differential diagnoses and incites clinicians to consider multiple pathologies in specific clinical settings.

Relapse of skull osteoma after hydroxyapatite cement cranioplasty: Case Report

In this case report, we present an extremely rare and previously unreported case of skull osteoma relapse without any attachment to the skull after hydroxyapatite cement (HAC) cranioplasty. The 49-year-old male patient was admitted with recurrence of the left frontal skull lesion; he underwent craniectomy and HAC cranioplasty for a left frontal osteoma 14 years before. Intraoperative findings disclosed multiple irregular lesions located on the HAC flap without any attachment to the bony structure and the roots of the lesions originating from the outer layer of the dura through several reserved holes. Pathological diagnosis was osteoma. The purpose of this report is to document this rare occurrence and provide the most probable pathogenesis for this rare event.

Middle Ear Osteoma With Assimilation of Ossicles: An Unusual Case of Conductive Hearing Loss

We present a case report of a middle ear osteoma presenting as gradual unilateral conductive hearing loss in a healthy 32-year-old lady. The decision for treatment was influenced by the relatively small burden of the disease, and the size and location of the osteoma, which made the decision for surgical excision prohibitively difficult. Taking patient wishes and circumstances into account, the decision was made for a bone conduction hearing implant in conjunction with close follow-up.

Choroidal Neovascular Membranes in Retinal and Choroidal Tumors: Origins, Mechanisms, and Effects

Choroidal neovascularizations are historically associated with exudative macular degeneration, nonetheless, they have been observed in nevus, melanoma, osteoma, and hemangioma involving the choroid and retina. This review aimed to elucidate the possible origins of neovascular membranes by examining in vivo and in vitro models compared to real clinical cases. Among the several potential mechanisms examined, particular attention was paid to histologic alterations and molecular cascades. Physical or biochemical resistance to vascular invasion from the choroid offered by Bruch's membrane, the role of fibroblast growth factor 2 and vascular endothelial growth factor, resident or recruited stem-like/progenitor cells, and other angiogenic promoters were taken into account. Even if the exact mechanisms are still partially obscure, experimental models are progressively enhancing our understanding of neovascularization etiology. Choroidal neovascularization (CNV) over melanoma, osteoma, and other tumors is not rare and is not contraindicative of malignancy as previously believed. In addition, CNV may represent a late complication of either benign or malignant choroidal tumors, stressing the importance of a long follow-up.

An Uncommon Case of Peripheral Osteoma of the Maxilla: A Case Report

Facial bone osteomas are uncommon, with only a few cases reported in the literature. Osteomas are benign neoplasms that are composed of well-differentiated, mature bones. There are three types of osteomas: central osteomas that develop from the endosteum, peripheral osteomas (PO) that develop from the periosteum, and extra-skeletal soft tissue osteomas that develop from the muscle. Both central and peripheral osteomas of the facial bones have been described. Peripheral osteomas have been reported in the frontal, ethmoid, and maxillary sinuses, but they are uncommon in the jawbone. It occurs at a younger age but is most prevalent in the sixth decade, with a female-to-male ratio of 1:2. The purpose of this case report was to examine the clinical manifestation and management protocol of such lesions using electrocautery.

Gardner's syndrome: Simultaneous diagnosis and treatment in monozygotic twins

Gardner's syndrome (GS) is a very rare autosomal dominant multisystem disease. Osteomas, skin and soft tissue tumors are present with gastrointestinal polyposis. The polyps have very high malignancy potentials. If prophylactic resection is not performed, colorectal cancer development is inevitable in all patients with GS. Polyposis is usually asymptomatic. Therefore, careful evaluation of extraintestinal findings of the disease is very important for early diagnosis. In this article, diagnosis and treatment of GS are presented in monozygotic twins, which have not been previously described in the literature. The diagnostic process, which started with dental complaints of one case, was carried out in an effective manner and then, prophylactic surgery was performed in twins. This article aimed to make clinicians and dentists attentive for early diagnosis of disease and to review treatment options.

An Unusual Cause of Hearing Loss: Incudal Osteoma

Osteoma is common in the temporal bone but extremely rare in the middle ear cavity and incus. Computed tomography plays an important role in the diagnosis of this slow growing benign osseous mass. The treatment of this lesion, which usually causes conductive type hearing loss, includes follow-up and surgery according to the patient's condition.

Drainage and Orbitofrontal Reconstruction After Removal of a Giant Frontal Sinus Osteoma: A Case Report

After removal of a large frontal sinus osteoma in this case, the contralateral nasofrontal canal was opened to drain the intraoperative fluid and prevent infection, and the defect in the orbitofrontal area was restored using a titanium mesh designed with 3D printing technology.

Multimodal imaging in choroidal osteomas

Choroidal osteoma is a rare benign tumor which is found in the posterior pole of the eye. We herein describe multimodal imaging in two cases of choroidal osteoma. Fundus of our first case showed a yellowish-orange colored subretinal lesion at the posterior pole. Multicolor imaging highlighted the lesion with greenish hue. Infrared reflectance showed hyporeflectance. A dense echogenic plaque persisting in lower gain was noted on B-scan. FFA showed hyperfluorescence with corresponding hypocyanescence on ICG. EDI OCT showed an increase in choroidal thickness with elevated retinal pigment epithelium. The second case showed choroidal osteoma with active choroidal neovascular membrane that responded to intravitreal injection of Ranibizumab.

Intracranial Osteoma: Unusual Etiology of Chronic Daily Headaches

Headache is one of the most frequent complaints in the outpatient department. The types of headaches can be broadly classified into primary and secondary. The primary headaches have benign intrinsic causes and include tension, migraine, and cluster headaches. A detailed history and appropriate physical examination are essential in assessing patients with headaches.  We present the case of a 33-year-old woman who presented to our primary care clinic with three days history of worsening frontal headache. She had been experiencing this headache daily for the last three months; however, the current episode is more severe. The headache episode was not associated with fever, neck stiffness, or loss of consciousness. She often became nauseated with the headache. There was no history of weakness, numbness, or visual disturbances with the headache. There was no family history of migraine headaches. On examination, no focal neurological deficit was noted. The head CT scan showed the presence of two highly hyperdense foci in the frontotemporal region, one of them was related to the dura. Such foci were not causing midline shift or brain edema. The preliminary diagnosis was calcified meningioma. Surgical excision of the lesions was planned. The patient underwent right craniotomy under general anesthesia. The two osseous lesions were observed and successfully resected. Histopathological examination of the lesions was consistent with osteoma. Intracranial osteoma is a very rare benign neoplasm of the mature bone tissue. The typical clinical manifestation of intracranial osteoma is a chronic headache. Head CT shows a well-defined, hyperdense structure. However, this is often mistaken as calcified meningioma.

IDIOPATHIC SCLEROCHOROIDAL CALCIFICATIONS. A CASE REPORT

AIM

Sclerochoroidal calcifications (SCHC) are an uncommon benign ocular condition that occurs in elderly patients. SCHC usually manifest as multiple placoid yellow lesions in the midperipheral fundus, most often in the upper temporal quadrant. They are asymptomatic and often discovered during routine eye examinations in a patient with good visual acuity and visual field. According to the etiology, SCHC are divided into idiopathic, metastatic and dystrophic.

CASE REPORTS

This is case report of 2 patients with idiopathic SCHC, who underwent basic eye examinations, fundus photography, optical coherence tomography, ultrasonography, fluorescein angiography, fundusautofluorescence, laboratory screening and in the second case also CT head scan.

CONCLUSION

The aim of this publication is to point out the typical features of SCHC and their distinction from more serious conditions that they may resemble.

[On the question of choosing a surgical approach when removing an osteoma of the external auditory canal]

The article presents the results of the surgery treatment of osteomas in external auditory canals of 24 patients. The quantity and the location of osteomas with respect to the tympanic membrane determine a surgical approach. Retroauricular approach (n=19) was applied in cases of multiple osteomas or their close location with the tympanic membrane. Single osteomas located laterally of the isthmus of the external auditory canal were removed with the endaural approach (n=5). The overall follow-up period was 5 years. Postsurgical supervision did not register illness recurrence or any complications such as the trauma of the tympanic membrane or the stenosis of the external auditory canal.

Craniofacial Osteomas: From Diagnosis to Therapy

An osteoma is a benign bone lesion with no clear pathogenesis, almost exclusive to the craniofacial area. Osteomas show very slow continuous growth, even in adulthood, unlike other bony lesions. Since these lesions are frequently asymptomatic, the diagnosis is usually made by plain radiography or by a computed tomography (CT) scan performed for other reasons. Rarely, the extensive growth could determine aesthetic or functional problems that vary according to different locations. Radiographically, osteomas appear as radiopaque lesions similar to bone cortex, and may determine bone expansion. Cone beam CT is the optimal imaging modality for assessing the relationship between osteomas and adjacent structures, and for surgical planning. The differential diagnosis includes several inflammatory and tumoral pathologies, but the typical craniofacial location may aid in the diagnosis. Due to the benign nature of osteomas, surgical treatment is limited to symptomatic lesions. Radical surgical resection is the gold standard therapy; it is based on a minimally invasive surgical approach with the aim of achieving an optimal cosmetic result. Reconstructive surgery for an osteoma is quite infrequent and reserved for patients with large central osteomas, such as big mandibular or maxillary lesions. In this regard, computer-assisted surgery guarantees better outcomes, providing the possibility of preoperative simulation of demolitive and reconstructive surgery.

FUNDUS AUTOFLUORESCENCE PREDICTING GROWTH OF A CHOROIDAL OSTEOMA IN A 13-YEAR-OLD GIRL

PURPOSE

To describe multimodal imaging findings, including fundus autofluorescence, in a patient with a growing choroidal osteoma.

METHODS

Case report.

RESULTS

A 13-year-old girl presented with an asymptomatic lesion in the superonasal macula of her left eye. Vision was correctable to 20/20 in both eyes, and the only significant finding on examination was the yellow flat lesion in the left macula. It measured 0.8-disk areas in size. Ocular coherence tomography showed a space occupying lesion in the choroid that had horizontal hyper-reflective lines consistent with cancellous bone. Re-examination in a year showed enlargement. Fundus autofluorescence showed no abnormalities in either eye. Ultrasonography showed a hyper-reflective lesion with associated shadowing that was consistent with a choroidal osteoma.

CONCLUSION

Normal fundus autofluorescence was seen in this young girl with a growing choroidal osteoma. Fundus autofluorescence is a proxy for the health of the retinal pigment epithelium. Normal retinal pigment epithelium is the only factor found to be predictive of future growth of a choroidal osteoma. This noninvasive test may prove useful as a guide to determine frequency of examinations especially in younger patients who might be prone to more rapid growth.

A Case of Giant Ethmoid Sinus Osteoma

Paranasal sinus osteomas are slow-growing benign tumors. They are generally asymptomatic in most patients and usually diagnosed incidentally with a sinus radiograph or more frequently with a CT scan of the paranasal sinuses. Osteomas can cause various signs and symptoms, depending on the location of the mass. Giant osteomas of the paranasal sinuses are very rare, with only a handful of case reports in the literature. Due to the rarity of giant osteomas, the clinical presentation and treatment are unclear. In this article, we present a case of giant ethmoid sinus osteoma, which was removed with an endoscopic endonasal approach, as well as a review of the literature.

Management of a case of osteoma of coronoid: A rare case report

Coronoid process osteoma is an extremely unusual and slow growing tumor which causes functional limitations of the temporomandibular joint. Till december 2014 only 7 cases have been reported worldwide. This case report is about a 40 year old male patient with osteoma of left coronoid process. Treatment plan constitutes of surgical resection of the mass and post operative physiotherapy.

Imaging Review of Pediatric Benign Osteocytic Tumors and Latest Updates on Management

Pediatric benign osteocytic tumors include osteoma, enostosis, osteoid osteoma, and osteoblastoma. In pediatric populations, benign bone tumors are more common than malignancies. Benign osteocytic tumors may have a unique clinical presentation that helps narrow the differential diagnosis. A systemic imaging approach should be utilized to reach the diagnosis and guide clinicians in management. Radiographs are the most prevalent and cost-effective imaging modality. Cross-sectional imaging can be utilized for tissue characterization and for evaluation of lesions involving complex anatomical areas such as the pelvis and spine. Computed Tomography (CT) is the modality of choice for diagnosis of osteoid osteoma. CT scan can also be utilized to guide radiofrequency ablation, which has been found to be highly effective in treating osteoid osteoma and osteoblastoma. Enostosis is a no-touch lesion. Osteoma is commonly located in the paranasal sinuses. Osteoma needs an excision if it causes complications due to a mass effect.

Surgical management of rare benign tumors of the sternum

Primary benign tumors of the sternum are an exceedingly rare entity. Surgical techniques regarding intervention for these lesions are not clearly defined in the literature given their scarcity. Operative techniques include en-bloc resection of the tumor, and this has proven to be successful in preventing local recurrence despite benign nature of the lesion. Given the often extensive defect created by the excision, reconstruction is frequently necessary; depending on the size of the defect, either autologous bone grafting or the use of synthetic materials may be indicated. This study serves to present two cases of rare primary benign tumors of the sternum, giant cell tumors and osteoma spongiosum and to summarize the available literature. We present a review of the literature of 17sternal giant cell tumor cases reported so far including our patient and unique case of osteoma spongiosum of the sternum, that discusses their surgical management, as well as reconstructive techniques that provided an excellent clinical result and a lack of recurrence on long term follow-up.

A Rare Case of Intra-Articluar Osteoid Osteoma of the Elbow Managed With Arthroscopic Excision

Osteoid osteoma (OO) of the elbow is a very rare entity as it typically occurrs in the lower extremity of extra-articular long bones. Hereby, we report a case for a 28-year-old female patient has been diagnosed with a unique presentation of sub-periosteal osteoid osteoma in the intra-articular portion of distal humerus. She underwent arthroscopic excision for the lesion which is considered a reliable minimally invasive management modality. In addition to this, findings of a 1-year follow-up after excision is reported.

Gardner syndrome with odontogenic sinusitis: A case report

Gardner syndrome with odontogenic sinusitis is rare but should be suspected in patients with multiple osteomas of the skull and facial bones, excess teeth, impacted teeth, and odontomas. Early diagnosis and treatment of GS may improve prognosis.

Giant frontal sinus osteoma and its potential consequences: illustrative case

BACKGROUND

Osteomas of the paranasal sinuses are benign, slow-growing bone tumors that can cause a variety of clinical features depending on their size and location. Most osteomas are asymptomatic and located in the frontal sinus. In rare cases, they may grow to extend into the cranial or orbital cavities, resulting in atypical presentations. The authors presented an aggressive case of a frontoethmoidal sinus osteoma with intracranial extension of an inflammatory sinonasal polyp.

OBSERVATIONS

A 30-year-old man with a history of chronic sinusitis presented to the hospital after three episodes of loss of consciousness, chronic worsening of headache, and decreased sense of smell. Rhinoscopic examination showed mucosal polyps arising from the infundibulum and the superior meatus. Computed tomography showed a fibro-osseous mass in the left frontal sinus. Subsequent brain magnetic resonance imaging with and without contrast revealed a large, septated intracranial left frontal lesion approximately 6.5 cm in diameter that was compressing the underlying brain parenchyma.

LESSONS

Intracranial extension of frontal sinus osteomas can have dire neurological implications. Early detection of lesions obstructing the paranasal sinuses outlet could prevent intracranial extension of the disease. The surgical approach to such tumors may be endonasal, open cranial, or a combination of both.

Lateral maxillary sinus floor elevation in the presence of a sinus osteoma: A case report

Eventhough the lateral sinus floor elevation is a well-documented procedure, many factors can increase its difficulty. The presence an osteoma can be very challenging and must be managed with caution taking in consideration the lesions's size and extension.

[Osteoma of lingual base: a case report]

Osteoma of lingual base is a rare disease which consists of well-developed bone surrounded by epithelial tissue on the surface of tongue. This article reported a case of osteoma of lingual base in the oral-cavity. The patient was admitted to hospital on March 2019 and developed foreign body sensation in pharynx in the last 2 weeks, without pharyngeal pain and fever, cough and sputum, breathing and swallowing difficulties. No obvious abnormality was found in chest radiograph, electrocardiogram and biochemical test of hematuria. There was a nodular mass in the size of 0.7 cm×0.8 cm×0.4 cm on the left side of the base of the tongue, which was higher than the surface of the base of the tongue. The surface of the mass was smooth, gray in color, with clear boundaries of touch, no tenderness, and hard texture. The clinical diagnosis was a mass at the base of the tongue.

[Inferior turbinate neoplasms]

INTRODUCTION

The main aim of the work was to describe a rare clinical case of osteoma of inferior turbinate. The interest of the case is that such tumors are extremely rare.

RESULTS

A female patient of 63 years old attended an ENT clinic. She complained on absence of nasal breath at the right side and headache. After a full ENT-examination, anamnesis, and a thorough analysis of the radiation examination results (computed tomography data), a decision was made to surgical treatment. Under general anesthesia, controlled hypotension surgery was done. First step was septoplasty, then the dense bone tumor was reduced and removed. At the control examination in 3 months, the complete removal of the formation of the inferior turbinate on the right is determined. There were no signs of continued or recurrent tumor growth.

CONCLUSION

Neoplasms of the nasal cavity, in particular the inferior turbinate, are extremely rare pathologies. They are mainly detected when performing anterior rhinoscopy, endoscopic examination of the nasal cavity. The result of histological examination is compact osteoma. The gigantic size of the inferior turbinate osteoma in our case is probably due to the patient's failure to consult a specialist (otorhinolaryngologist) for a long time. Surgical treatment of this pathology should consist in an endoscopic endonasal approach: this approach allows the most complete and minimally traumatic removal of the tumor.

A rare case in childhood: Pott's puffy tumor developing secondary to frontal sinus osteoma

Pott’s puffy tumor is a rare and serious complication of frontal sinusitis, characterized by the development of osteomyelitis and subperiostal abscess in the frontal bone. Paranasal sinus osteomas are benign osteoblastic tumors, usually seen in the 3^rd and 4^th decades of life. In this report, we present a case of Pott’s puffy tumor due to frontal sinus osteoma in an adolescent male patient. In the literature, we found no similar case in the pediatric age group and we wanted to emphasize the development of Pott’s tumor as a rare complication of chronic or recurrent sinusitis and draw attention to the fact that paranasal sinus osteomas may be the underlying cause.

[A case of isolated sphenoid osteoma with suppurative sinusitis in a 15-year-old child]

Isolated sphenoid osteomas are very rare even in adults. There are extremely few publications on pediatric cases of sphenoid osteomas. This paper presents a case of isolated sphenoid osteoma combined with suppurative sphenoiditis in a 15-year-old patient. The child presented with persistent headache resistant to medical treatment. Endoscopic sphenotomy allowed both to remove osteoma and to relieve the symptoms of sinusitis. The presented case can be considered as the third detailed description of the sphenoid osteoma in children and the first demonstration of the effectiveness of the endoscopic approach for its removal.

[The effectiveness of the use of local antibacterial drugs in the postoperative period in a patient with a neoplasm of the external auditory canal]

This article presents clinical case of external auditory canal osteoma and postoperative management of this patients. In this publication the etiology of this pathology, as well as the clinical manifestations that accompany this pathological condition are described. We present a literature review and our own experience of treatment this group of patients.

Spinal Osteoid Osteoma Revealed by Radiculopathy: Case Report and Literature Review

Osteoid osteoma (OO) is a benign tumor that usually occurs in long bones of young males. We report a rare case of spinal OO in a 25-year-old woman, revealed by a sciatica. Spinal radiographs and computed tomography scan were normal, although performed at 6 months of symptom evolution. On magnetic resonance imaging, however, an important edema of the right transverse process of L5 vertebrae was depicted but was inconclusive. The diagnosis of OO was finally retained on a second computed tomography scan with thinner slices focused on the edematous area. The patient had an en-bloc excision of the tumor with complete regression of symptoms. Due to the atypical clinical presentation and the absence of common findings in imaging, the diagnosis was delayed by 12 months. Radiculopathy caused by spinal OO is a rare condition with no more than 30 cases reported in the literature. In fact, spinal OO usually presents with inflammatory back pain or painful scoliosis. This case emphasizes the importance of early suspicion and diagnostic interventions in the detection and treatment of OO.

A Novel Modification of the Sagittal Split Osteotomy as an Access Osteotomy

Pathologies present in the central zone of the mandible are difficult to access, primarily because of the presence of the inferior alveolar nerve (IAN) and the need to remove a large corticocancellous component to reach the area of interest. Many times, this bony window is replaced as a free graft and there is complete resorption in the long term or even rejection of the graft causing a bony defect which can weaken the mandible. Furthermore, the damage to the IAN is profound. To try and avoid these comorbidities the traditional sagittal split osteotomy was modified to access a central osteoma impinging on the IAN and the successful removal of the same without any comorbidities such as paraesthesia or loss of bone structure. We believe that this modification can be used for other scenarios such as benign cysts and difficult presentations of impacted teeth.

Subdural Empyema Complicating a Giant Fronto-Ethmoidal Osteoma

Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. We present an unusual case of a giant frontal sinus osteoma leading to subdural empyema formation. Determine the origin and the optimal surgical approach of these unusual lesions by analyzing giant osteomas of the frontal and ethmoidal sinuses in the literature. We report a rare case of giant frontoethmoidal osteoma with intracranial extension in a 34-year-old man, revealed by seizures. Neuroradiological studies revealed frontoparietal subdural empyema associated to a large osteoma in the right frontal sinus. The patient underwent surgical evacuation of the empyema and resection of the osteoma in one stage operation of decompressive craniotomy. The patient recovered very well after surgery and postoperative antibiotic therapy. This case represents in the literature only the third-reported case of subdural empyema complicating frontoethmoidal osteoma. The surgical treatment options, including open surgery techniques and endoscopic approaches, as well as pathogenesis are discussed according to the relevant literature.

Giant craniofacial osteoma with orbital invasion

Craniofacial osteomas, which involve orbits, can cause several problems, such as displacement of the globe, diplopia, and refractive changes. We report the case of a young man with diplopia and blurred vision, with a giant osteoma occupying right frontal and ethmoid sinuses, encroaching into his right orbit. The symptoms resolved 3 months after surgery. Our case highlights the successful surgery for a symptomatic craniofacial osteoma with orbital invasion.

Bifocal parosteal osteoma of femur: A case report and review of literature

Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or compact bone. Osteoma usually is a solitary lesion, but in patients with Gardner’s Syndrome it may be multiple. osteoma may rarely have a parosteal localization. Parosteal osteoma has peculiar radiographic, histologic and clinical features. We describe a case report of a 51- years old man with a bifocal parosteal osteoma of the femur in a non-syndromic patient. This is the first described patient with a bifocal lesion. In literature only 24 cases of paraosteal osteoma are found. Our patient underwent surgery and the lesions were fully excised. At one year follow-up there was no evidence of recurrence.

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.

Multiple Osteomas of Eustachian Tube Causing Ipsilateral Otitis Media

BACKGROUND

Middle ear ventilation and the drainage of secretions are the basic functions of the eustachian tube. Eustachian tube (ET) dysfunction can lead to otitis media. Multiple causes of ET dysfunction exist; ET obstruction is one of them. Osseous obliteration of ET is quite rare. In the literature, there are two cases of solitary osteoma and a case of hamartoma with an osseous content in the ET. Herein, this report describes the case of a patient with multiple osseous lesions consistent with osteomas in the ET, causing ipsilateral otitis media with CT findings.

CASE REPORT

A 53-year-old woman presented with left-sided intermittent otalgia and otorrhea. Temporal bone computed tomography showed opacification of middle ear consistent with otitis media and nearly complete blockage of the left ET lumen with multiple osseous lesions wall probably consistent with osteomas on the left side.

CONCLUSION

There are limited data about the radiological features of ET osteoma due to its rare occurrence. Radiographically, external ear osteoma generally appears as a single pedunculated hyperdense mass on CT scan originating from the tympanosquamous or tympanomastoid suture line and extending into the auditory canal with otherwise preserved canal dimensions. Considering this information, osseous lesions arising from ET bone wall and extending into the lumen in the present case were considered as osteomas. Especially in the case of unilateral chronic otitis media, ET should not remain a neglected anatomical area.

Compact osteoma of the maxilla: A rare case report

Osteomas of the facial bones are a rare entity and very few cases have been reported in the literature. Osteoma is a benign osteogenic lesion with a very slow growth, characterized by proliferation of either cancellous or compact bone. This paper describes a case of a 27 year old male seeking treatment for a slowly enlarging lesion in the maxillary right anterior region. Surgical excision of the lesion was done and the histopathologic evaluation revealed dense compact bone with osteocytes in the lacunae suggestive of compact osteoma. One year followup showed no evidence of recurrence. To best of our knowledge this is the twelfth case of maxillary osteoma reported in English language literature.

Retromastoid osteoma-a rare case report

Osteomas are slow growing bone tumours and are often asymptomatic. Rarely, they can be present in the temporal bone-only few cases had been reported, with an incidence of 0.1-1%. We describe a case of an osteoma of the temporal bone (retromastoid) found in a 40 year old female, who presented with a slow growing swelling behind the right ear for 9 years. Diagnosis was made on non-contrast computed topography (CT) of the skull. Treatment is indicated in symptomatic cases or cosmetic reasons. Screening colonoscopy and genetic testing for familial adenomatous polyposis (FAP) and Gardner's syndrome are advised.

Transpalpebral Frontal Sinus Septectomy: Feasibility and Results

Background

Transpalpebral frontal septectomy (TFS) can be performed for unilateral frontal sinusitis drainage (into the contralateral healthy frontal sinus) or to provide access to the lateral extent of the contralateral frontal sinus. This procedure has demonstrated its usefulness in several problematic situations for the endoscopic surgeon.

Objective

The main objective of our study was to evaluate the feasibility of TFS. Secondary objectives were to define outcomes, early and late complications, contraindications, and failure rates of the TFS.

Methods

We reviewed patient demographics including age and gender, indication for frontal septectomy, prior surgeries, failure rates and necessity of revision surgery, early and late complications, and the side of the approach (ipsi- or contralateral to the frontal sinus pathology). Twenty patients who had undergone TFS were included. Patients were classified into 2 groups according to the surgical indication: group 1—TFS performed for unilateral frontal sinusitis to drain a frontal sinus in the contralateral frontal sinus; and group 2—TFS performed to provide access to the lateral extent of the contralateral frontal sinus. Scarring was assessed using the SCAR-Q questionnaire.

Results

TFS was performed on all patients in Groups 1 and 2 (success rate = 100%). No patients had recurrence of the pathology 6 months after surgery (0%). No patient needed revision surgery (0%). One complication (frontal hypoesthesia) was reported 6 months after surgery. Mean SCAR-Q score was 99.3 ± 2.5 (min = 91/100, max = 100/100).

Conclusion

TFS was feasible for all patients in this study. This procedure permits drainage of the frontal sinus and gives access to the lateral extent of the contralateral frontal sinus, without visible scarring, and with few lasting complications. Authorization to conduct this study was obtained from the Ethical Committee of our institution (APHM, n°2019_65).

Osteoid Osteoma in the Thumb of an Adolescent Patient

Osteoid osteoma is a relatively common benign tumor of bone, typically presenting in the diaphysis of long bones during the second or third decades of life. This tumor is rarely reported in the hand and wrist, making up only approximately 10% of cases. When reported in the hand, osteoid osteoma tends to occur more frequently in the proximal phalanx of the index and middle fingers. We present the case of an osteoid osteoma in an adolescent male in the distal phalanx of the thumb. The presentation of this osteoid osteoma was atypical owing to its location and lack of characteristic clinical features, making the initial work-up and final diagnosis challenging and pointing to the importance of considering this diagnosis on a differential for painful bony tumors in the hand.

Frontoethmoid Osteoma Causing Tension Pneumocephalus

Tension pneumocephalus is a life-threatening condition that is characterized by the accumulation of intracranial air, causing increased intracranial pressure. Paranasal sinus osteomas are common, slow-growing benign tumors usually diagnosed incidentally. Paranasal sinus osteomas causing tension pneumocephalus have been very rarely reported.