Abordagens cirúrgicas para os osteomas dos seios paranasais

Abstract

Surgical approaches to the paranasal sinuses osteoma Resumo / SummaryOs osteomas são os tumores benignos mais freqüentes dos seios paranasais, apresentam crescimento lento e são em sua maioria assintomáticos. O tratamento cirúrgico destes tumores, ainda, é um tema controverso no que tange suas indicações e a escolha da abordagem cirúrgica. Existem diversas opções cirúr-gicas que vão desde as abordagens externas clássicas até as transnasais assistidas por vídeo-endoscopia. Não existem indicações formais para cada uma das abordagens devendo-se sempre levar em conta o tamanho do tumor no momento da escolha da abordagem a ser empregada. Objetivo: Neste estudo apresentaremos seis casos de osteomas dos seios paranasais operados no Hospital Prof. Edmundo Vasconcelos, São Paulo-SP com diferentes abordagens cirúrgicas em função de peculiaridades de cada caso, discutiremos as indicações da cirurgia e também as opções cirúrgicas mostrando as vantagens e desvantagens de cada abordagem. Forma de estudo: Estudo de série.

Paranasal sinus osteoma: review of literature

“…Savic et al . proposed that ethmoidal sinus osteomas should be resected regardless of their size. Others have proposed that osteomas should be resected when they are still small in size.…”

“…When they produce symptoms, headache or facial pain localised over the area of osteoma is the most common one 27,29 followed by epistaxis 3,45 . The most frequent symptom in patients with osteomas of ethmoidal sinuses is frontal headache or facial pain (53%) [7][8][9]26,27 , frequently secondary to ostium obstruction or infection of the sinus. Sphenoid sinus osteoma's most common clinical presentations are, in decreasing order, headache, invasion and deformity of the orbit, pneumocephalus with possible rhinorrhea and meningitis, and, rarely, abscess formation.…”

“…Smith proposed that asymptomatic and minimally symptomatic patients could be followed by serial radiographs but that surgery is indicated if the lesion fills the frontal sinus by more than 50% by volume 13 . Savic et al proposed that ethmoidal sinus osteomas should be resected regardless of their size 7,9,21 . Others have proposed that osteomas should be resected when they are still small in size 45 .…”

“…Osteoma is a type of benign bone-forming tumour occurring most commonly in craniofacial skeletal structures, mainly in the nasal and paranasal regions. The frontal sinus (37-80%) [1][2][3][4][5][6] is most frequent location, followed by the ethmoid 20% 7,10 , maxillary sinus, and sphenoid sinus, respectively [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . Sphenoid sinus osteoma is extremely rare 15 .…”

“…Although osteomas may occur at any age, they are most frequently found in people over 40 years old 7,10,[23][24][25][26][27][28][29] . Some authors have reported that the tumour is more common in young adults, with peak incidence from 10 to 20 years [30][31][32] .…”