Surgical management of osteomas of the frontal recess and sinus: extending the limits of the endoscopic approach

Abstract

Osteomas are among the most common benign tumors of the paranasal sinuses. Symptomatic osteomas are most often found in the frontal recess and the frontal sinus. While the extranasal approach is still a part of the treatment concept for removing osteomas at this localization, over the last years the endoscopically controlled endonasal approach has greatly gained in importance due to the improved surgical equipment. We retrospectively analyzed the surgical indication, surgical approach and outcome of the removal of osteomas of the frontal recess and the frontal sinus performed at our hospital between 1996 and 2010. The exact surgical technique, intra- and postoperative complications, the duration of the hospital stay and the follow-up and subjective contentment of the patients were evaluated. With a total of 24 patients being included, the study comprises one of the largest groups of patients with osteomas of the frontal recess and sinus. Over the study period, the frequency of the endoscopic approach clearly increased. Previously suggested guidelines for the endoscopic resection of a frontal sinus osteoma turned out to be superseded. Endoscopically controlled resection even of large, adversely located osteomas of the frontal recess and the frontal sinus is becoming increasingly possible, but is still naturally limited by the individual anatomic conditions and the need for experienced surgeons.

Paranasal ossifying fibroma: endoscopic resection or wait and scan?

“…Based on improved endoscopes and instruments, the further development of operation techniques (e.g. ''four-hand-technique'') [18] and the routine application of precise navigational systems, the limits of the endoscopic approach could be extended over the last decades [12]. In accordance, the three surgically treated paranasal ossifying fibromas presented here could be removed exclusively endoscopically controlled.…”

“…In recent years, the resection of paranasal ossifying fibromas by an endoscopic approach has markedly increased, paralleling an extension of the limits of endoscopic techniques in paranasal sinus surgery as a whole [12]. However, as the ossifying fibroma is a very rare condition, no larger series exist in the literature.…”

Endoscopic Resection of Giant Ethmoidal Osteoma With Intraorbital Extension

“…(18) Endoscopic management of osteomas of the paranasal sinuses reduces the overall morbidity without sacrificing outcome. (19,20) …”

Osteomas of the nose and paranasal sinuses: A review of literature

“…По мнению авторов, только остеомы I и II степени могут быть удалены эндоскопически [38]. Однако в более новых исследованиях продемон стрировано успешное эндоскопическое удаление опухолей III и IV степени [39,40]. Суммируя выше перечисленные факты, можно сделать вывод, что трансназальный эндоскопический доступ все чаще является эффективной альтернативой открытому варианту хирургического вмешательства.…”

“…Чаще всего изза жесткой струк туры опухоли приходится прибегать к парциальному удалению новообразования [36]. Иногда при пора жении лобной пазухи задняя стенка может быть ис тончена или даже полностью отсутствовать, в таких случаях рекомендовано ее укрепление во избежание пролабирования лобной доли мозга [36,40].…”