Paranasal sinus osteoma: review of literature

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.

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.

The earliest known case of frontal sinus osteoma in man

Frontal sinus osteoma is a relatively common finding in the modern clinical setting. Although, its paleopathological record is not in dispute, its presence in Ancient Egypt has never been clarified. The aim of this article is to contribute to the debate. An Egyptian mummy head from the Musée d'Éthnographie de Neuchâtel (Switzerland) was studied radiologically and the obtained evidence was contextualized in the wider frame of multidisciplinary paleopathology. A 128-slice CT scanner was used for further investigation; datasets were processed with OsiriX-64 bit (version 5.8.5), and multiplanar (MPR) and volumetric reconstructions were performed. A small hyperdense and well-defined structure, most likely an osteoma, was identified in the right frontal sinus. Frontal sinus osteoma definitely existed in Ancient Egypt. Finally, this represents the oldest case in anatomically modern humans so far reported. Clin. Anat.32:105-109, 2019. © 2018 Wiley Periodicals, Inc.

Reconstruction of the anterior wall of the frontal sinus by a custom-made titanium prosthesis after resection of a giant osteoma of the frontal sinus

Osteoma is a benign, usually asymptomatic bone tumour, frequently arising in the nose and paranasal sinuses. Surgical treatment is required when the patient becomes symptomatic or presents ophthalmological or neurological complications. Although an endoscopic approach is increasingly used, depending on the size and site of the osteoma, open surgery may be preferable and remains the standard treatment. This technical note describes a case of giant osteoma of the frontal sinus that required a bicoronal approach with reconstruction by a custom-made titanium prosthesis.

Did Antonio Vallisneri (1661-1730) really describe frontal sinus osteoma? Unexpected insights for paleo-neuroparasitology

It has been believed for a long time that the Paduan scholar Antonio Vallisneri (1661-1730) described the second historical case of the frontal sinus osteoma in 1733. By historico-medically reexamining this case, we conclude that the brain concretions he described were not a case of frontal sinus osteoma, while they appear to have been pathological outcomes of neurocysticercosis, whose larval stages would only be described by Johann Goeze (1731-1793) later, in 1784. Thus, this case becomes relevant for the history of neuroparasitology.