Ethmoid osteoma with frontal and orbital extension: Endoscopic removal and reconstruction

Abstract

Endoscopy provides a safe and effective way of treating craniofacial bony benign lesions. This approach permits not only complete removal of the tumour, but also reconstruction of the bony boundaries as necessary. Osteoma is a rare, osteogenic tumour that usually grows slowly and asymptomatically. It is the most frequent benign neoplasm of the nose and paranasal sinuses. Orbital extension is a rare event that can give rise to ocular signs and symptoms; in such a case treatment is mandatory, although debate persists regarding the optimal approach. We report the case of a bulky fronto-ethmo-orbital osteoma that was treated using an endoscopic trans-nasal approach. The medial wall of the orbit was repaired by means of an implant of porous polyethylene endoscopically positioned using an "underlay" technique. The surgical technique is described and the reasons for the endoscopic choice are also discussed. Fifteen days after the operation the patient reported complete resolution of craniofacial pain. Nasoendoscopy showed complete integration of the polyethylene implant in the healing tissue 4 weeks after surgery. A CT scan performed 6 months postoperatively showed good ventilation of the sinonasal cavity and effective reconstruction of the medial orbital wall.

Short‐term outcomes of purely endoscopic endonasal resection of orbital tumors: a systematic review

“…No systematic reviews or controlled trials were identified in the literature. Thirty‐nine studies contained data for patients who met the inclusion criteria . Of the studies included, 21 were case reports, 8 were case series, and 10 were retrospective chart reviews.…”

Validity of sampling error as a cause of noncorrelation

“…They extended naturally in the direction of the orbit and 6 of the 25 cases exhibited an orbital extension of the osteoma; this caused diplopia in 4 cases. A total of 8 cases of orbital extension of the ethmoid osteoma has been reported in the literature 7, 12–17. The other path of natural extension is toward the frontal sinus, which occurred in 7 of the 25 cases in our series.…”

“…There are 2 options for the management: clinical observation (if the patient is asymptomatic and does not want to undergo an operation) or surgery. The surgical option involves risks, such as bony disruption of the orbital wall and the anterior skull base (with a putative risk of meningitis and cerebral abscess); however, a bony disruption without dural injury typically remains asymptomatic and a dural tear can be repaired without permanent damage 15. In our series, we reported only 1 postoperative complication: a frontal mucocele diagnosed 5 years after the removal of the osteoma.…”

Successful medical treatment of an orbital osteoma in a dog

“…This would require reconstruction of the defect to avoid possible development of sinusitis or orbital emphysema and prevent herniation of the orbital tissue into the sinus space 8 . Reconstruction of severe orbital defects in humans using bone grafts and different synthetic materials has been previously described 34–37 . One study described significant cranial and partial orbital reconstruction after radical osteoma resection in a dog using a polymethylmethacrylate mold 10 .…”

“…8 Reconstruction of severe orbital defects in humans using bone grafts and different synthetic materials has been previously described. [34][35][36][37] One study described significant cranial and partial orbital reconstruction after radical osteoma resection in a dog using a polymethylmethacrylate mold. 10 However, the same study reported severe complications (emphysema, recurrent bacterial infections, tissue necrosis) in a case of removal of multilobular tumor of bone, in which orbital reconstruction was achieved using the same technique.…”