Ethmoid osteoma with frontal, nasal and orbital extension: case report and literature review

Abstract

Introduction: Osteomas are rare slow growing benign osteogenic tumours which are almost exclusively restricted to the craniofacial skeleton. These lesions are often asymptomatic however they may exhibit a variety of symptoms and signs which depend on the location, dimension and extension of the tumour. Case description: We report on a case of an 11-year-old boy with a 3-week history of headaches, facial asymmetry, right orbital proptosis and diplopia on extreme upward gaze. Computed tomography and magnetic resonance imaging demonstrated a calcified mass of the right ethmoid sinus with extension into the frontal sinus, nasal wall and orbit with proptosis of the right globe. The patient underwent a bicoronal flap incision with an osteoplastic frontal sinus flap. The abnormal bone was debulked from the orbit roof and medial wall, ethmoid sinuses and frontal sinus with frontal sinus cranialization. The defects were reconstructed with grafts from the iliac crest. Facial symmetry and resolution of proptosis and diplopia was achieved without complications. Histological examination confirmed the diagnosis of Osteoma. After a 3-year follow-up period, he remained asymptomatic and without recurrence. Conclusion: Surgical treatment is indicated for symptomatic osteomas, although debate persists regarding the optimal approach. Recurrence of these tumours after resection is rare.