A Case of Large Ethmoid Sinus Osteoma Resected by Endoscopic Endonasal Surgery

Abstract

Paranasal sinus osteoma may be treated surgically when the lesion is large and symptomatic, and shows significant invasion. We report the case of a 47 mm ethmoid sinus osteoma with orbital invagination. The lesion was resected in minimally invasive endonasal surgery. A 79-year-old man was diagnosed with an ethmoid sinus osteoma, so-called “orbital osteoma”, that had partially penetrated the anterior orbital internal wall. In endoscopic endonasal surgery under general anesthesia, the fixed osteoma in the middle meatus, including orbital invagination, was slowly and continuously mobilized to expand the movable range within the nasal cavity. To reduce volume, the osteoma was cut in two using an otological drill. After the columella—the mobile part of the nasal septum—was incised transversely to enlarge the external nostril, individual parts of the osteoma were removed through the enlarged nostril. The surgery detailed here shows how a large paranasal sinus osteoma, conventionally requiring exonasal incision, is resectable with minimal invasion via endoscopic endonasal surgery.