Giant Osteomas Research Articles

Unveiling the Giants: A Descriptive Study of Giant External Auditory Canal Osteomas – An Uncommon Clinical Odyssey

Abstract Background: External auditory canal (EAC) osteoma, an uncommon manifestation within the mastoid bone, emerges as a particularly intriguing subject of study. Despite its low prevalence, the emergence of giant variants of these osteomas presents unique clinical and therapeutic challenges. Aim and Objectives: The study focuses on five patients presenting with giant bony osteomas, aiming to elucidate the prevalence, clinical features, radiological aspects, and optimal management strategies of these lesions. Material and Methods: Patients were selected from those presenting to the ear, nose, and throat outpatient department at a tertiary hospital between June 2022 and June 2023. Diagnosis was established through clinical examination and high-resolution computed tomography scans of the temporal bone. The diagnostic process underscored the importance of imaging studies in confirming osteoma characteristics, differentiating them from other conditions like exostosis. Management primarily involved surgical excision using a novel “eggshell thinning” technique to ensure minimal damage to the EAC skin and preserve natural canal contours. Results: The patients, predominantly young males, presented with symptoms ranging from hearing loss to ear pain and aural fullness. The outcomes across the cases were optimal, with surgical interventions resulting in symptom resolution. Notably, the innovative eggshell thinning technique facilitated complete removal while preserving skin flap integrity in 80% of cases. The contour of canal was well maintained. Conclusion: This research highlights the importance of recognizing and addressing the distinctive features of giant osteomas in the EAC. The findings emphasize the effectiveness of the surgical approach utilized, characterized by minimal trauma and successful preservation of skin flap integrity. The study calls for continued research and documentation to refine strategies for managing such rare entities, underscoring the necessity for a patient-centered, multidisciplinary approach in otologic surgery.

A Giant Frontoethmoidal Ivory Osteoma Causing Cosmetic and Visual Problem: A Case Report.

Osteomas are slow growing fibro-osseous lesions. Very rare to occur in paranasal sinuses. Small osteomas don't require any intervention. Giant osteomas may require surgical intervention due to its cosmetic and functional compromises. A 28year old male presented with swelling over forehead and left orbit for more than 4years. The swelling is around 6 × 5cm with gross lateral and inferior deviation of left eyeball. Extradural fronto-ethmoidectomy was done with combined external and endoscopic approach. There was pearly white bony hard, fixed tumor mass seen infiltrating anterior and posterior table of frontal bone. All the tumors removed in piecemeals. Wait and watch policy is the usual treatment policy for small and asymptomatic osteomas. Combine external and endoscopic approach is the treatment of choice for giant frontoethmoid osteoma.

Pediatric Cases of Recurrent Skull Giant Osteoma Misdiagnosed as Fibrous Dysplasia.

Osteomas are benign mature bone tumors that typically arise in the skull. Osteomas larger than 3 cm in diameter are considered giant osteomas. Giant osteomas of the skull vault are very rare, especially in children; therefore, only a few cases have been reported in the literature. Although osteomas are usually asymptomatic, a large skull mass can cause headache, as well as esthetic disfigurement of the forehead. it can be misdiagnosed as other conditions, such as fibrous dysplasia, ossifying cephalhematoma, or other malignant bone tumors. Herein, the authors report 2 rare pediatric cases of giant osteomas mimicking fibrous dysplasia and their successful surgical excision. These cases showed good results without recurrence or complications on long-term follow-up after complete excision.

Giant frontal sinus osteoma - case report and literature review

Osteomas of paranasal sinuses larger than 3 cm are classified as giant osteomas. A considerable size of these tumors may result in serious complications as well as pose a substantial surgical challenge. We present a case of an adult man with a giant osteoma of right frontal sinus. The neoplasm was removed in an open approach with incision along the brow bridge; an injury to the supraorbital nerve was avoided. The osteotomy was performed with piezosurgery. The anterial wall of the right frontal sinus was reconstructed with bone fragments bound together by titanium plates and mesh. The following discussion presents different possibilities of surgical removal of giant paranasal osteomas.

УДАЛЕНИЕ ГИГАНТСКИХ ОСТЕОМ ФРОНТОЭТМОИДАЛЬНОЙ ОБЛАСТИ С ОДНОМОМЕНТНОЙ РЕКОНСТРУКЦИЕЙ ДЕФЕКТА ЛИЦЕВОЙ СТЕНКИ ЛОБНОЙ ПАЗУХИ

Objective: To develop an appropriate method for removing giant frontoethmoidal osteomas and the immediate reconstruction of the anterior wall of the frontal sinus. Methods: Between 2016 and 2020, five patients (4 men and 1 woman) were admitted with an osteoma of the paranasal sinuses, of which three (2 men and 1 woman) were diagnosed with giant osteomas of the frontal and ethmoid region. The patients were aged 28 to 49 years. Routine clinical examinations were carried out, including collecting patient history and a CT scan of the paranasal sinuses. The giant osteomas were removed by minimally invasive transnasal endoscopic surgery with a combined anterior wall approach to the frontal sinus. The tumour size was reduced by excision with a surgical drill before removal to minimise the defect in the frontal sinus's anterior wall. The procedure was completed with the immediate reconstruction of the anterior wall of the frontal sinus using titanium nickelide mesh. Results: The length of hospital stay was 10 days. Wound healing occurred by primary intention, and the sutures were removed on the 8th day. Followup periods were between 1 month and 1 year. Follow-up examinations were carried out 1 week, 1, 6 and 12 months after hospital discharge. On the follow-up CT scans performed a year after the operation, the implanted titanium nickelide mesh was stable, the aeration of the frontal sinus was normal, and satisfactory cosmetic outcomes were reported. Conclusion: CT is the gold standard in determining the size of the osteoma, its spread, and the state of the walls of the paranasal sinuses. A combined surgical approach and debulking of the giant osteomas using a surgical drill with the immediate reconstruction of the anterior wall of the frontal sinus by titanium nickelide mesh produce favourable outcomes. Keywords: Osteoma, benign tumour, frontal sinus, surgical treatment, frontal recess, titanium nickelide mesh.

Multiple Giant Skull Osteomas Associated with Gardner's Syndrome.

Multiple Giant Skull Osteomas Associated with Gardner's Syndrome.

Giant osteomas: Clinical results and surgical approach from ophthalmic point of view.

To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit. Retrospective, interventional, case series. The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded. Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12-70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete (n = 2/6) or partial (n = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia (n = 5/6), vision loss (n = 2/6) exophthalmos (n = 6/6) and reduced pupillary light reflex (n = 2/6). The presumed origin of the tumor was frontoethmoidal region (n = 2/6), frontal sinus (n = 3/6) and ethmoid sinus (n = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary, n = 4; permanent, n = 2). Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.

A Very Rare Benign Giant Osteoma in Tempero-parieto-occipital Region

Osteoma is a slow growing benign mesenchymalosteoblastic tumor formed by maturebone tissue. The most common site reported is the fronto-ethmoidal region andneighboring sinuses.Involvement of the temporal and occipital squama is extremelyrare. Like giant osteomas in other locations of the skull, they can reach large volumesbut are essentially benign and potentially curable by excision.The author present acase of giant osteoma in Temporo-Parieto-Occipital region in a teenage girl. Bang. J Neurosurgery 2020; 9(2): 173-177

Giant fronto-ethmoidal osteoma with orbital and intracranial extension: a case report

<p class="abstract">Osteomas of the paranasal sinuses are often small, asymptomatic and incidentally diagnosed on radiological imaging. Giant osteomas, although rare, are clinically significant due to their propensity to cause orbital and intracranial complications. Complete surgical resection is usually possible with good outcome and low recurrence rate. We report a case of 62 years female who presented with proptosis and blurring of vision. Radiological work up revealed giant fronto-ethmoidal osteoma measuring 7.9×5.1×4.8 cm extending into the orbit and along the anterior skull base. Open surgical excision of the osteoma was done via left fronto-orbital approach. This is one of the largest fronto-ethmoidal osteomas reported in the literature till date.</p>

Mastoid Osteoma – Is “Trauma” A Possible Etiologic Factor

A 19 year old female presented with painful postaural swelling of three years duration with preceding history of trauma. Clinically and radilogically the diagnosis of mastoid osteoma was made. As patient was symptomatic the osteoma was removed and cortical mastoidectomy was done. We emphasise that symptomatic mastoid osteomas must be treated early even if they are small in size to prevent the development of giant osteomas. The case is reported for its rarity with relevant review of literature. To the best of our knowledge this is the first case report in which there is a definitive history of trauma preceding the development of osteoma suggesting its possible role as an inciting factor.

Giant fronto-ethmoidal osteoma – selection of an optimal surgical procedure

IntroductionOsteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator. ObjectiveDetermine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature. MethodsGroup of 37 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied. ResultsThe authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p=0.2691) and the frontal sinuses (p=0.5891). ConclusionThe choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques.

Reconstructing a Giant Frontal Osteoma With Porex

Osteomas are the most common benign tumors of the paranasal sinuses. They are usually localized in the frontal sinus. Giant osteomas of the frontal sinuses are very rare but readily extend into the intraorbital or intracranial cavity, causing serious complications. This is a report of a 14 year-old boy with a bulging in frontal area and asymptomatic giant osteoma of the frontal sinuses. He had a history of minor trauma that had a bulging after 3 months. However, he referred to a plastic surgeon after 15 months. Computed tomography of the sinuses revealed a 3.5 × 6 cm extremely dense bony mass in the frontal sinus that extended into the left orbit and ethmoid sinus. A bicoronal frontal flap was raised with a V-shaped skin incision starting from the tragus placed 5 cm posterior to the hairline. The osteoma was resected completely in the frontal sinus and the anterior wall of frontal sinus was reconstructed with Porex. The patient has not had any complications until the time of writing this report. Titanium mesh may still be a valuable option, but Medpore Porex has shown to be quite effective in this case.

A VARIANT OF CLINICAL MANIFESTATION OF FRONTAL SINUS OSTEOMA COMBINED WITH PYOCELE OF THE ETHMOIDAL LABYRINTH

Osteoma is benign tumor that grows from the bone, often localized in the frontal sinuses (up to 70% of cases), characterized by slow growth, and 2 periods are distinguished in its development - latent and evident, in which symptoms develop stipulating the patient to refer to an ophthalmologist, neurologist , otolaryngologist. Diagnosis is made on the base of clinical manifestation and X-ray evidence (osteoma on the radiograph as an intense focus shading) and computed tomography when the correct diagnosis is made, as well as its size, topographic anatomical correlation with adjacent areas, as well as osteoma structures to solve the issue of surgery and plan of the operation. Sometimes there is a combination of giant osteomas of the paranasal sinuses with mucocele of the ethmoid labyrinth with severe clinical manifestation, with orbital complications observed in this clinical case requiring urgent surgery.

Giant osteomas of the ethmoid and frontal sinuses: Clinical characteristics and review of the literature

Giant osteomas of the ethmoid and frontal sinuses ary very rare, with only a few dozen cases reported in the literature. Given their rarity, the clinical characteristics and treatment of this disease remain controversial. In this study, the clinical presentation and surgical methods used to treat three patients with giant osteomas of the ethmoid and frontal sinuses are described, combined with a review of the literature from 1975 to 2011. In total, 45 patients with giant osteomas arising from the ethmoid and frontal sinuses (including the present cases) have been reported in 41 articles. Headache and ocular signs are the most common symptoms. This disease often leads to intracranial or intraorbital complications. The main treatment for giant osteoma is surgery via an external approach. The outcome of surgery for giant osteoma is good, with rare recurrence, no malignant transformation and few persistent symptoms.

Giant Cranial Osteoma

Craniofacial osteomas are benign, slow-growing neoplasms of the craniofacial region that are usually asymptomatic. Uncommonly, giant craniofacial osteomas may be symptomatic and cause serious morbidity including ophthalmologic problems, cerebral compression, pneumocephalus, and seizures. We present a case of a 15-year-old Asian adolescent girl with a giant cranial osteoma (17.5 × 13.2 × 5 cm: significantly larger than previously reported). She also had multiple other synchronous giant osteomas of the face causing facial asymmetry. These osteomas were resected in a multiple-staged approach with a good aesthetic and functional outcome.

Endoskopowe leczenie olbrzymich kostniaków podstawy czaszki

Osteomas are relatively common, benign, slow-growing neoplasms. Mainly occurring in frontal and ethmoid sinuses. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. We discuss our experiences in endoscopic treatment of giant osteomas. In giant osteomas Draf III or Lothrop approaches are prefered. Periostium of the orbit was intact in all cases. Discharge of cerebrospinal liquid was not observed. Size of tumor determines type of surgical aprroach. Endoscopic surgery is more and more popular way in surgical treatment of giant osteomas.

A giant, complex fronto-ethmoidal ivory osteoma: Surgical technique in a resource-limited practice

Background:Unlike small and medium size fronto-ethmoidal osteomas which are amenable to surgical excision through limited craniofacial openings, giant lesions require extensive and complex craniofacial dissection, and post lesionectomy reconstruction using an array of modern-day surgical adjuncts. This is a report of our surgical technique for the successful and esthetically fair operative resection of a giant fronto-ethmoidal osteoma in a difficult practice setting.Case Description:A 32-year-old Nigerian lady harbored a giant complex fronto-ethmoidal ivory osteoma. Deploying our understanding of modern-day advanced microsurgical anatomy and technique of skull base surgery, but under severe resource limitations, a radical total surgical resection was performed and an esthetically fair post lesionectomy reconstruction was achieved. The patient remains tumor-free in 20 months, so far, of postoperative follow-up.Conclusions:Even under severe resource limitations, inventive adaptations of modern-day skull base surgery techniques can facilitate hitherto unusual functional and esthetically successful resection of giant osteomas of the fronto-ethmoidal sinus complex.

Orbital Osteoma Of Ethmoidal Origin

Introduction: Osteoma is the most frequent benign tumor of paranasal sinuses. Various theories have been advanced to explain the pathogenesis with difficulty to establish cause-effect relationship. Generally osteoma are asymptomatic and usually discovered by chance during radiological imaging. Resection of small and medium-sized osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques with very good cosmetic effects. Giant osteomas can be effectively approached by a combined external and endoscopic procedure. Observation : Mr K.A. is a 19 years-old Caucasian male who came to consultation for a swelling of the medial angle of the left eye. Computed tomography images showed a ethmoidal process displaying a bone density consistent with an osteoma. The tumor was removed through an external ethmoidectomy. The patient was free of symptoms at 15 months follow-up. Conclusion: The rarity of ethmoidal osteoma with orbital growth made our cases interesting to report.

Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty

BackgroundOsteomas of ethmoid sinus are rare, especially when they involve anterior skull base and orbit, and lead to ophthalmologic and neurological symptoms.Case presentationThe present case describes a giant ethmoid osteoma. Patient symptoms and signs were exophthalmos and proptosis of the left eye, with progressive visual acuity impairment and visual fields defects. CT/MRI scanning demonstrated a huge osseous lesion of the left ethmoid sinus (6.5 cm × 5 cm × 2.2 cm), extending laterally in to the orbit and cranially up to the anterior skull base. Bilateral extensive polyposis was also found. Endoscopic and external techniques were combined to remove the lesion. Bilateral endoscopic polypectomy, anterior and posterior ethmoidectomy and middle meatus antrostomy were performed. Finally, the remaining part of the tumor was reached and dissected from the surrounding tissue via a minimally invasive Lynch incision around the left middle canthus. During surgery, CSF rhinorrhea was observed and leakage was grafted with fascia lata and coated with bio-glu. Postoperatively, symptoms disappeared. Eighteen months after surgery, the patient is still free of symptoms.ConclusionBefore management of ethmoid osteomas with intraorbital and skull base extension, a thorough neurological, ophthalmological and imaging evaluation is required, in order to define the bounders of the tumor, carefully survey the severity of symptoms and signs, and precisely plan the optimal treatment. The endoscopic procedure can constitute an important part of surgery undertaken for giant ethmoidal osteomas. In addition, surgeons always have to take into account a possible CSF leak and they have to be prepared to resolve it.