Giant Osteoma in the Mastoid of the Temporal Bone: Complete Excision of a Rare Tumor

Experience with three-dimensional exoscope-assisted surgery of giant mastoid process osteoma

BACKGROUND

The excision of a giant mastoid process osteoma can be challenging. In such situations, the three-dimensional exoscope intra-operative optic may be a promising tool.

CASE REPORT

This paper provides a technical description of a giant mastoid osteoma excised under three-dimensional exoscope magnification. A fragmented excision by intralesional curettage was adopted to prevent peri-tumoural damage. This technique had been previously described for the excision of large osteomas of the sinus.

CONCLUSION

The three-dimensional exoscope magnification tool had excellent applicability during surgery of a rare mastoid osteoma. In complex anatomical areas, the cavitation and fragmented excision of the tumour may prevent complications and is therefore recommended.

Protuberant Fibro-Osseous Lesion of the Temporal Bone: "Bullough Bump"-Multimodality Imaging Case Series and Literature Review

A handful of cases of protuberant fibro-osseous lesions of the temporal bones have been described in the literature to date, with primary focus on the pathologic features. Here we review 3 cases of pathology-proved protuberant fibro-osseous lesions of the temporal bone and include a literature review with a focus on the imaging features. While rare, these lesions have near-pathognomonic imaging features defined by a location at the cortex of the outer table of the temporal bone at the occipitomastoid suture, lack of involvement of the underlying marrow, variable mineralization, and MR signal characteristics atypical of a chondroid lesion. One case in this series was FDG-avid and had occasional mitotic features, possibly reflecting an aggressive variant. Neuroradiologists should be familiar with this benign diagnosis to aid in timely identification and avoid unnecessary additional imaging.

Spongiotic osteoma in the external auditory canal: Two cases of a rare tumor

Osteoma of the external auditory canal is a rare benign tumor with an estimated incidence of 0.05% of total otologic surgeries. In most cases, an osteoma in the external auditory canal does not cause symptoms because the tumor grows slowly and does not occlude the ear canal. However, if the mass grows to occlude the external auditory canal, several symptoms can occur, including conductive hearing loss, aural fullness, and keratin debris accumulation. We present two cases of this rare tumor in a 23-year-old woman and a 19-year-old man. The mass was surgically excised at the level of the peduncle under local anesthesia with microscope assistance. The base of the excised mass was drilled with a diamond burr to remove all osseous lesions. Histopathologic findings showed spongiotic osteomas. In these cases, patients had symptoms of aural fullness, although the osteomas did not completely occlude the external auditory canal, and the symptoms improved after surgical excision without recurrence.

Rare Tumors Presenting as a Mastoid Mass

In terms of diagnosis, a painless isolated mass lesion around the mastoid area is rarely encountered in general practice. In the present study, we report two cases of painless benign mastoid tumors located in the postauricular region. The first patient visited our department with a painless progressing mass lesion behind the right ear, which was later revealed as an intramuscular lipoma in the mastoid origin site of the sternocleidomastoid muscle. The second patient similarly presented to our department with a chief complaint of a painless, palpable mass in the mastoid region. Biopsy results confirmed the diagnosis of an osteoma. In both cases, the tumor was surgically removed by a postauricular approach. Although osteoma and lipoma are benign tumors rarely involved in the mastoid area, presenting without symptoms, it is recommended of complete excision, especially in cases with symptoms or cosmetic deformity.