Giant fronto-ethmoidal osteoma - selection of an optimal surgical procedure

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.

Management of Nasal Bone Osteoma with Columella Approach: A Case Report

BACKGROUND: Osteoma is a benign bone tumor with an incidence rate of about 1% of primary bone tumors. Osteoma of the nasal bone is a rare case and the rate of recurrence reported in the literature after surgery is about 10%. Osteoma most often occurs in young people in the second and third decades, mostly in men. Osteoma can be treated surgically with an external approach or with an endoscopic approach. The surgical technique with an incision technique open rhinoplasty with transcolumella incision extensions is effective, because it can minimize surgical scars post-operative and correct the esthetic problems. CASE REPORT: Reported a case of a 11-year-old boy with chief complaint a lump on the right side of the nose that enlarged slowly in the last 2 months and diagnosed with suspected as nasal bone osteoma based on physical examination and CT Scan. Patient was performed management with tumor resection with columella approach technique and give the good result because can minimizes surgical scars postoperative. On the results of histopathological examination after operation were nasal bone osteoma. CONCLUSION: Osteoma of the nasal bone is a very rare benign bone tumor. One of the surgical techniques that can be performed in cases of nasal bone osteoma is tumor resection with columella approach. Although the case of nasal bone osteoma has a very rare recurrence; in this case, the recurrence occurred 4 months after tumor resection.

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.

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

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

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

Total removal of a giant frontal sinus osteoma with orbital extension - A case report

The Rationale:

Osteomas are benign tumours that are usually asymptomatic. However, giant osteomas can lead to severe complications. We report here the management of a giant frontal sinus osteoma with orbital extension.

Patient Concerns:

We present the case of a 17-year-old patient presenting with rapidly progressive isolated right exophthalmos.

Diagnosis:

A cerebral computed tomography scan was performed and showed a giant osteoma of the right frontal sinus extending to the orbit and massively eroding the anterior wall of the frontal sinus.

Treatment and Outcomes:

The patient underwent surgery and a complete removal of the osteoma was accomplished via an open approach, but without performing a bone flap. No recurrence was observed after 2 years of follow-up.

Take-away Lessons:

Although rare, giant frontal osteomas can cause severe functional impairment due to their proximity to noble structures. Therefore, open approach remains the mainstay of therapy.

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.

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.

Bilateral Transorbital and Transnasal Endoscopic Resection of a Frontal Sinus Osteoblastoma and Orbital Mucocele: A Case Report and Review of the Literature

OBJECTIVE

Describe a novel treatment approach to a rare bony neoplasm in the frontal sinus.

STUDY DESIGN

Case report.

METHODS

Retrospective chart review of an osteoblastoma of the frontal sinuses complicated by a right orbital mucocle. Demographic, endoscopic, radiographic, pathologic, and surgical data were collected for synthesis and review. MEDLINE, Embase, and Cochrane databases were searched from 1977 to 2017 to review publications of surgical management of frontal sinus neoplasms.

RESULTS

A single female patient with a large frontal sinus osteoblastoma was successfully treated with a bilateral transorbital and transnasal approach. The right orbital mucocele was marsupialized into the frontal sinus. Gross total resection of the tumor was achieved, with complete resolution of the presurgical morbidity. The surgery was tolerated well without iatrogenic injury or sequela.

CONCLUSION

Frontal sinus osteoblastoma is a rare condition. Complete surgical excision is considered curative. Various endoscopic and open approaches have been described. Here we show the feasibility and efficacy of a multiportal strategy in the successful management of a large frontal sinus osteoblastoma complicated by a right orbital mucocele.