Surgical Treatment of Paranasal Sinus Osteomas: A Single Center Experience of 58 Cases

Endoscopic Excision of Frontal Recess Osteoma in a Patient With Nasal Polyposis

Paranasal sinus (PNS) osteomas are benign growths that are usually asymptomatic and often discovered incidentally upon imaging. Nasal polyps, on the other hand, are relatively commoner than osteomas. With the adoption of endoscopic technology in the otorhinolaryngology (ORL) field, surgeons are shifting toward less invasive surgical methods in managing such cases. We present a case of a 23-year-old male who had chronic rhinosinusitis with nasal polyps. A computed tomography (CT) done as part of his preoperative planning revealed findings suggestive of nasal polyps with left frontal recess osteoma. Both pathologies were removed successfully via an endoscopic endonasal approach.

Long-term persistent discomfort due to a giant frontoethmoidal osteoma despite complete surgical removal - A case report

Introduction

Giant frontoethmoidal osteomas are rare, slow-growing, benign osseous tumours, frequently causing severe life impairing symptoms due to their proximity to noble structures. Initially, osteomas are often diagnosed on radiographs by chance. Their aetiology can be considered ambiguous. They may either be treated by active observation, medical therapy, radio and thermal therapy, or surgery.

Case presentation

We report the case of a 56-year-old female patient with a giant osteoma spreading from the nasal cavity to the entire frontoethmoidal sinus, leading to headaches, respiratory problems, and nausea for several years. For a period of 20 years, a watch and wait approach was applied. Finally, the osteoma was removed using a combined open and endoscopic approach. One year after the operation, a secondary mucocele developed, accompanying headaches and facial pressure due to its continuous expansion. Despite numerous consultations, she refused surgical intervention until today.

Discussion

Early detection and removal of frontoethmoidal osteomas improves the prognosis for a favourable treatment outcome. The smaller the osteoma, the easier it can be removed endoscopically. The decision to perform surgery was made when the condition drastically affected the patient's quality of life. To date, there is still no strong consent regarding the best surgical approach and the best time to do it.

Conclusion

The combination of open and endoscopic surgery remains a safe and straightforward procedure for the removal of giant frontoethmoidal osteomas. Early detection and intervention are crucial for a predictable minimally invasive treatment with a favourable outcome for the patient.

•

Early removal of frontoethmoidal osteomas improves the prognosis for a favourable minimally invasive treatment outcome.

•

The smaller the osteoma, the easier it can be removed exclusively by endoscopy.

•

The combination of open and endoscopic surgery remains a safe and uncomplicated procedure for the removal of giant frontoethmoidal osteomas.

Clinical experience and treatment approaches in sinonasal osteomas from a Tertiary Care Hospital in Turkey

OBJECTIVE

Osteomas are slow-growing benign osseous tumors that particularly located in the paranasal sinuses (PS). Here, we aimed to define the clinical symptoms and features, diagnostic conditions caused by osteomas located in four different PSs, to evaluate the surgical indications and methods, to compare the factors that can affect the surgical decision, radiological findings, and prognosis.

METHODS

The data of patients with paranasal sinus lesions and diagnosed as osteoma according to the radiological imaging, who applied to our clinic between 2010 and 2020, were retrospectively collected and re-evaluated in the light of clinical, radiological, and pathological data. Patients who underwent surgical treatments and were definitively diagnosed as osteoma by pathology were enrolled in this study.

RESULTS

We presented the data of 117 patients retrospectively. Most of these cases (n = 77, 65.8%) had an osteoma located in the frontal sinus, while 32 cases (27.4%) had osteoma in the ethmoid, two cases (1.7%) had in sphenoid and six cases (5.1%) had in maxillary sinus. We found that the presence of symptoms, diameter of osteoma, surgical indications including state of sinus drainage, and chronic/recurrent sinusitis influence the choices of physicians in management of frontal sinus osteomas. Moreover, we found a significant correlation between the grading systems defined to classify the frontal sinus osteoma to be operated (r = 0.878, 95% CI: 0.724-0.949, P<0.0001).

CONCLUSION

There are several grading systems useful for the choice of surgical approaches, however, the clinical symptoms and surgical indications should not be neglected in the follow-up of patients with frontal sinus osteoma. If there are concerns about the grade of osteoma and the endoscopic approach is considered not to be sufficient for resection, the surgical procedure may be initiated endoscopically, and, if necessary, it can be combined with an external approach.

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.

Surgical treatment of frontal sinus osteoma

OBJECTIVE

The purpose of this study was to describe our experience in the surgical treatment of frontal sinus osteomas.

METHODS

This study involved 18 patients who underwent surgery for frontal sinus osteoma between January 2016 and December 2019. Demographic characteristics, site and size of osteoma, presenting symptoms, frontal sinus osteoma grading system, presence of frontal sinusitis, surgical methods, treatment outcome, operation time, and complications were reviewed.

RESULTS

The endoscopic approach was performed in all patients except one. Among patients who underwent an endoscopic approach, endoscopic sinus surgery was performed in ten patients and endoscopic-modified Lothrop procedure was performed in seven patients. The mean size of the frontal sinus osteoma was 1.5 ± 0.7 cm. According to the frontal sinus osteoma grading system, grade III (n = 9, 50.0%) was the most common, followed by grade II (n = 4), grade I (n = 3), and grade IV (n = 2). The size of the osteoma and frontal osteoma grading system exhibited statistical significance with the operation time (p < 0.05). There were no major surgical complications or recurrence.

CONCLUSION

The operation time was prolonged when the frontal sinus osteomas were more than 1.5 cm or in grade III and IV frontal osteomas.

Osteoma involving the olfactory groove: evaluation of the risk of a CSF leak during endoscopic surgery

Purpose

The olfactory groove (OG) is a common site of iatrogenic cerebrospinal fluid (CSF) leak during endoscopic sinus surgery. We aimed to evaluate the prevalence of CSF leak during endoscopic removal of osteomas involving the OG and identify CT findings indicating increased risk of this complication.

Methods

A retrospective review was conducted of patients operated on for frontoethmoidal osteoma from 11 years in a single institution. A retrospective review of the literature, 1999 to 2019, of perioperative complications in patients operated on for frontoethmoidal osteoma using endoscopic or combined approaches.

Results

Case series: 73 patients were identified including 17 with the OG involvement. The only case of CSF leak occurred in a patient with spongious part of osteoma at the OG. Among six osteomas with spongious component at the OG, one was detached and five had to be drilled down, leaving a small remnant in four. In contrast, all the 11 osteomas with ivory part at the OG were safely detached and completely removed from the OG after debulking. The prevalence of CSF leak was not statistically different between the patients without and with involvement of the OG. Systematic review of the literature: Among the 273 identified patients there were 8 cases of intraoperative CSF leaks (3%) including 2 from the OG (0.7%).

Conclusion

Involvement of the OG does not significantly increase the risk of intraoperative CSF leak. However, this risk may be increased in patients with the spongious part of the tumor attached to the OG.

Surgical treatment of unusual osteoma associated with homolateral radicular cyst of the maxillary sinus

Introduction: We described a rare clinical case of osteoma associated with homolateral radicular cyst of the maxillary sinus. Observation: Imaging showed two different lesions in the right maxillary sinus. We performed a combined surgical approach to completely remove the lesions and used a plasma rich in growth factors membrane to repair dental roots. No relapse after a 2 years follow-up was observed. Commentaries: The simultaneous presence of two large lesions, a 23,7 mm osteoma and a 33,7 mm radicular cyst in the same maxillary sinus, has been rarely described in the literature. Although nasal endoscopy and imaging are mandatory to assess the diagnosis, the definitive diagnosis was obtained after histopathologic examination. A combined surgical approach allowed a complete removal of both lesions, ensuring, at same time, an optimal surgical field. Plasma rich in growth factors membrane due to its cohesive properties was particularly useful in improving bone neoformation and periodontal regeneration. Conclusion: Diagnostic assessment of maxillary lesions requires nasal endoscopy, imaging and histopathological examination. If these lesions are symptomatic, they should be completely removed and minimally invasive surgery is indicated. Plasma rich in growth factors membrane ensures a good postoperative recovery.