Juvenile Ossifying Fibroma: Multiportal Endoscopic Trans-Nasal and Orbital Surgical Approaches, Histopathological and Radiological Findings

Abstract

Abstract: Ossifying fibroma of the nasal cavity and paranasal sinus is a benign tumor histologically, however clinically may show invasive characteristics. It has malignancy rate of 0.4–0.5%. Here, we presented a 2 rare cases of Ossifying fibroma in two female children with Juvenile ossifying fibroma of the paranasal sinuses with orbital involvement and reviewed the literature of this rare tumour. Both cases subjected to complete ENT and ophthalmological examination and investigated by CT study of the paranasal sinuses, orbit and brain using specific protocol. Both underwent excision of the lesions as much as accessible and applicable to avoid complications and morbidity through combined trans-nasal endoscopic and orbital approaches with repair of the orbital wall with titanium as in first case and high-density porous polyethylene sheets as in the second case. We did report some minor post-operative complications. Post-operative follow up included complete ENT and ophthalmological examination and Follow up CT. A histopathological feature of the first case is consistent with diagnosis of trabecular variant of ossifying fibroma, while the second case is consistent with the diagnosis of psammomatoid variant of ossifying fibroma. Radilogically there were partially defined expansile heterogeneous fibro-osseous mass with ground glass appearance occupying the right maxillary, ethmoidal sinuses, and the right nasal cavity and invading the orbit. Conclusion: The diagnosis of JOF is made by correlation of clinical, radiological, histopathological findings. A combined Trans- Nasal endoscopic and orbital approach is effective for adequate excision. Key Words: ossifying fibroma; juvenile aggressive ossifying fibroma; fibro-osseous lesion.