Osteoblastoma of the nasal septum

Refractory and progressively worsening nasal obstruction: case report of nasal osteoblastoma and literature review

Nasal osteoblastoma (OB) is a rare and locally aggressive osteogenic tumor that has rarely been reported, and there is a lack of effective evidence data for its diagnosis and treatment. In this study, we report a 31-year-old female patient who presented with nasal congestion and associated progressive painless swelling of the left maxillofacial region. A preoperative computed tomography (CT) examination of the paranasal sinuses was performed, and based on the imaging presentation, the surgeon was unable to differentiate between OB, osteoid osteoma (OO), fibrous dysplasia of bone (FDB) and osteoblastic fibroma (OF). After excluding contraindications to surgery, the patient underwent nasal endoscopic excision of the left nasal mass, which was found to be gravel-like and difficult to remove cleanly during the operation. The mass was brittle and bled easily, resulting in inadequate exposure of the operative field, prolonged operation time, and substantial intraoperative blood loss. This indicates that definite preoperative diagnosis (biopsy of deeper parts of the mass is recommended) and appropriate preoperative preparations (e.g., preoperative angiography and embolization, adequate blood preparation) are very important. The intraoperative frozen and postoperative pathological results clearly identified the tumor as OB. No local recurrence of the tumor was observed at the 11-month postoperative follow-up.

Sinonasal osteoblastomas in the middle turbinate: Two case reports

RATIONALE

Sinonasal osteoblastoma is an extremely rare benign bone-forming tumor.

PATIENT CONCERNS

We report 2 extremely rare cases of sinonasal osteoblastoma in the middle turbinate.

DIAGNOSES

The preoperative diagnosis was osteoma in the middle turbinate.

INTERVENTIONS

We performed endoscopic removal of the mass in the middle turbinate and frontal recess.

OUTCOMES

Histological examination of biopsy specimens revealed osteoblastoma.

LESSONS

Clinicians should consider osteoblastoma in the differential diagnosis of tumors arising in the nasal cavities.

Aggressive middle turbinate osteoblastoma with intracranial extension: a case report

Introduction

Osteoblastoma is an uncommon benign bone tumor that accounts for 1 percent of all primary bone tumors. About 30 to 40 percent of all osteoblastoma cases involve the spine. Osteoblastoma involving the nasal cavity is rare, with only 11 reported cases in the English-language literature, while only four cases of turbinate osteoblastoma have been described.

Case presentation

We report an unusual case of middle turbinate osteoblastoma associated with right-sided nasal obstruction and severe headache in a 14-year-old Caucasian girl. The tumor involved the right middle turbinate, complete anterior and incomplete posterior ethmoidal cells, and the frontal sinus ostium. Cribriform lamina was, in the most part, consumed by the tumor growth, while the skull base was mostly of normal bone structure.

Conclusions

To the best of our knowledge, this is the first case of middle turbinate osteoblastoma with intracranial spread. Surgical treatment is the only therapeutic option for osteoblastoma.

Epistaxis: the factors involved in determining medicolegal liability

BACKGROUND

The purpose of this study was to examine litigation involving epistaxis and analyze factors that determine liability.

METHODS

Jury verdicts and settlements regarding cases involving epistaxis were gathered utilizing the Westlaw database. Factors involved in litigation gathered included demographics, defendant specialty, procedure, alleged cause of malpractice, outcome, monetary award, and other variables.

RESULTS

A total of 26 cases were analyzed. The majority of cases (57.7%) were decided in favor of the plaintiff or settled out of court. Total awards amounted to $24,501,252. Average awards for cases decided in favor of the plaintiff were $2,260,893 and ranged from $499,845 to $9,022,643. Settlements averaged $1,084,375 and ranged from $300,000 to $3,800,000. Common causes of malpractice encountered included delay in diagnosis, complications from medical procedures, and failure to recognize complications in a timely manner.

CONCLUSION

Contrary to previous reports analyzing malpractice for varying medical procedures and complications, litigation in epistaxis is more commonly resolved in favor of the plaintiff or resolved through out-of-court settlements. Substantial financial awards and therapeutic complications from blindness to death make epistaxis a candidate for litigation. Of importance from a medicolegal stand is the fact that 30.8% (8) of the patients involved in epistaxis litigation died, either from complications of therapy or from experiencing epistaxis as a complication of another procedure/pathology. Using necessary diagnostic imaging, ensuring proper management techniques, and recognizing complications in a timely manner can serve to limit legal liability and enhance patient safety.

Benign osteoblastoma of the ethmoid sinus

Osteoblastoma is categorized as a benign bone-forming tumor, which occurs rarely in the craniofacial region. We report a case of osteoblastoma developed in the nasal cavity and ethmoid sinus in a 14-year-old girl whose chief symptom was nasal obstruction and exophthalmos on the right side. CT revealed the lesion having the same density as bone and a ground-glass border, expanding to the nasal and paranasal cavities. Complete removal was accomplished under endoscopic view, although the tumor was removed piece by piece. Histologic inspection showed exuberant osteoid trabeculae and immature bone formation by osteoblasts with vascularized connective tissue. We diagnosed the tumor as osteoblastoma based on the clinical presentation and the size of the tumor. No recurrence was evident at the 1-year follow-up visit.