Paranasal Sinus Osteomas Research Articles

A large atypical osteoma of the maxillary sinus: a report of a case and management challenges

An osteoma within the paranasal sinuses is a rare benign fibro-osseous tumour. Osteomas occurring in the maxillary sinus are exceedingly rare and account for only 5% of the cases. A case of a 38-year-old female with an osteoma of the maxillary sinus is presented and the disease and its management are discussed. A 2 cm spherical lesion in her right maxillary sinus was picked up incidentally on a magnetic resonance imaging scan whilst being investigated for unrelated neurological symptoms and in the absence of any sinonasal symptoms. An endoscopic biopsy demonstrated that the mass was an osteoma. The management of paranasal sinus osteomas is surgical and is governed by patient symptoms, tumour size and location, in the light of the risk of future intracranial or intraorbital complications. The choice of surgical approach is determined by the location of the tumour and, the experience of the surgeon. In this case a combined external and endonasal approach was the most appropriate management due to the size of the tumour and the risk of intraorbital complications. The patient underwent a combined Caldwell-Luc and transnasal endoscopic resection without complication.

Large Intracranial Intradural Mucocele as a Complication of Frontal Sinus Osteoma

Paranasal sinus osteomas are mostly asymptomatic; however, secondary mucocele can develop if they impede the natural sinus drainage. Such a mucocele can destroy the bone and extend into the adjacent structures. We report on an unusual case of frontal sinus osteoma in a 27-year-old patient, complicated by large secondary mucocele that eroded the bone and extended into the frontal lobe of the brain. Unexpectedly, the patient did not report any visual or other symptoms attributable to central nervous system deficit. The mucocele was completely resected through bifrontobasal osteoplastic craniotomy, whereas osteoma was evacuated in its entirety by both drilling and mobilizing. Open surgical approach remains the main treatment for complicated paranasal sinus osteoma, and radical removal of intracranial mucocele is mandatory to prevent the development of life-threatening infections. Although intradural extension of a secondary mucocele is extremely unusual, head and neck surgery specialists should take this severe complication in consideration.

A Prospective Study of Paranasal Sinus Osteomas in 1,889 Cases: Changing Patterns of Localization

A Prospective Study of Paranasal Sinus Osteomas in 1,889 Cases: Changing Patterns of Localization

A prospective study of paranasal sinus osteomas in 1,889 cases: Changing patterns of localization

We developed the largest paranasal sinus computed tomography (CT) scan study so far by including 1,889 cases to investigate the prevalence, localization, age distribution, and the secondary complications of paranasal sinus osteomas. Prospective study. A prospective study was performed on 1,889 consecutive adult individuals who underwent paranasal sinus CT examinations with suspected sinus disease. The prevalence of paranasal sinus osteomas was determined to be 3%. Osteomas were located most frequently in the ethmoid sinuses. The size of the osteomas varied from approximately from 2 to 30 mm. Of the osteomas found, 37%were accompanied by pathological sinonasal findings. The prevalence of sinonasal osteoma in the paranasal sinus region detected by CT scan is supporting the literature, whereas the localization pattern challenges it.

Frontal Sinus Osteoma Complicated by Extended Intracranial Mucocele and Cerebral Abscess: Neurosurgical Strategy of a Rare Clinical Entity

The combination of paranasal sinus osteoma, mucocele and brain abscess is rare. Only one other case has been reported so far, where the cerebral abscess was diagnosed intraoperatively. We report here on a second patient with combined frontal sinus osteoma, intracerebral mucocele as well as cerebral abscess. However, in our case, the diagnosis of cerebral abscess was reached prior to surgery, which allowed for a tailored treatment strategy with abscess puncture under neuronavigational guidance and, after 3 weeks of antibiotic therapy with documented abscess shrinkage, osteoma and mucocele resection as well as reconstruction of the eroded dura.

Osteomas of the Maxillofacial District

Maxillofacial district osteomas are benign lesions with very slow growth. The most frequent localization is the frontal sinus, about 57% of all paranasal cavity osteomas; less frequently, they can be located in the ethmoidal sinus or sphenoidal and maxillary. Etiology has not completely clarified yet; nevertheless, there are 3 main pathogenetic theories: osteogenic, traumatic, and infective. Open procedures represent the gold standard, but there is still an unsolved debate for the best treatment option. Endoscopic techniques offer an alternative approach, enabling closer and more direct visualization of the anatomy as well as avoiding damage to surrounding structures. In our study, we analyzed all patients treated with endoscopic approach for paranasal sinus osteomas in the ENT unit of the University of Varese and compared them with patients treated for the same pathology with open surgery in the Maxillo-facial Department of the University of Rome "La Sapienza." The purpose of the work was to compare the advantages and disadvantages of the 2 procedures. In conclusion, this study underlines the importance of flexibility in surgical approach decision, which must fit the different issues of the pathology and of the patient.

P.004 Endoscopic frontal osteoma removal

Osteomas are uncommon, slow-growing, benign osteogenic neoplasms that arise most frequently in the craniofacial skeleton.1, 2 Osteoma is the most common benign tumor of the nose and paranasal sinuses and the most common neoplasm of the frontal sinus.3, 4, 5 Paranasal sinus osteomas originate in the sinus wall, fill the lumen with well-defined mature osseous tissue, and occasionally extend into the orbit where they give rise to orbital signs and symptoms. Osteomas most commonly become symptomatic in the second to fifth decade in life, but orbital involvement has rarely been reported in patients aged 18 years and younger.2, 6, 7, 8, 9, 10 We report a case of a frontal sinus osteoma with orbital extension in a 13-year-old girl.

ETHMOID OSTEOMA WITH FRONTAL AND FRONTOBASAL EXTENSION

Paranasal sinus osteomas are benign slow growing tumors, occasionally known to cause complications for a long time. Frontobasal extension of paranasal sinus osteoma is an uncommon localization. We present a 20 year-old-man admitted to our clinic with a complaint of pus drainage and wound from forehead for 2 weeks. The radiological images of the patient revealed a mass mimicking osteoma and extending into the frontal sinus and frontobasal area with a chronic infection. The patient was initiated antibiotics for 2 weeks and the mass was extirped through the destructed anterior wall of frontal sinus. The histopathological diagnosis was osteoma and the patient was discharged uneventfully at the 7th day after the operation.

Paranasal Sinus Osteomas and Gardner's Syndrome

Osteomas are common benign tumors of the paranasal sinuses. The origin of these lesions is uncertain. Although most are asymptomatic, symptoms can include headaches, facial pain, rhinorrhea, and sinusitis. Osteomas are also seen as part of Gardner's syndrome, an autosomal dominant disease characterized by intestinal polyposis, osteomas, and cutaneous and soft tissue tumors. In affected individuals, the risk of developing colon cancer approaches 100%. On average, osteomas are detected 17 years before colon polyps appear. Three patients with maxillary or ethmoid osteomas and chronic sinusitis are presented. One of the patients had evidence of Gardner's syndrome, based on the presence of gastrointestinal symptoms and a positive family history of polyposis. Otolaryngologists should be aware of the possibility of Gardner's syndrome in patients with paranasal sinus osteomas. Suspected patients should have a complete workup for Gardner's syndrome, including lower gastrointestinal tract endoscopy, barium enema imaging, and DNA testing.

Update on Bone Forming Tumors of the Head and Neck

The production of bone by neoplastic cells that have an osteoblastic phenotype is the common trait of all bone forming neoplasms. The tumor bone can be lamellar or woven in architecture and may mimic cortical or cancellous elements. In benign tumors, the neoplastic bone usually consists of relatively well-formed trabeculae of woven bone, whereas in malignant bone forming tumors (osteosarcoma), it is usually deposited in a coarse lace-like pattern. Lamellar cortical-type neoplastic bone is generally only present in osteoma (and enostosis), however, it can rarely be a component of well-differentiated osteosarcoma. Osteoma Osteoma is a benign, slow growing bone forming tumor that consists primarily of well-differentiated mature, compact or cancellous bone. They usually arise on the surfaces of the cranial vault (outer table—exostotic and inner table—enostotic), jaw, paranasal sinuses, and orbit [17, 22, 42]. Cranial osteomas are named according to the bone from which they arise, whereas osteomas of the paranasal sinuses are designated in relation to the sinus which they invade [4]. In the paranasal sinuses, osteomas most frequently involve the frontal sinus, followed in descending order by the ethmoid sinus, maxillary antrum, and sphenoid sinus [11, 12, 30, 41]. Although rare in children, osteomas affect all age groups but are most commonly diagnosed in the fourth or fifth decades of life [12, 41]. Osteomas are often asymptomatic and are frequently an incidental finding on imaging studies performed for unrelated conditions. Osteomas when large or situated in a strategic location can cause a variety of signs and symptoms including painless swelling, facial asymmetry and symptoms secondary to nasal or paranasal sinus obstruction such as sinusitis, nasal discharge and mucocele formation [12, 13, 16, 45]. Orbital osteomas and paranasal sinus osteomas that protrude into the orbit can cause a variety of ocular abnormalities such as exophthalmos, proptosis, ptosis, diplopia, lid edema or swelling and amaurosis fugax [16, 46]. In extraordinary cases the tumor may grow intracranially and cause neurological complications [1]. Classically, osteomas manifest as a round well-circumscribed homogeneous radiodensity on radiographs; however, several different patterns of mineralization may be seen (Fig. 1) [11]. Open in a separate window Fig. 1 Axial CT of skull showing round well defined osteoma attached to the outer table

Endoskopowe leczenie chorych z kostniakami zatok przynosowych – doświadczenie własne

Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses, occurring mainly in frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, keep enlarging, are localised in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, irrespective of their size, in symptomatic tumours. Progressive headaches and chronic inflammation of the adjacent mucous membrane are most common symptoms. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim. The aim of the paper was to report own experience in endoscopic treatment of patients with osteomas of the paranasal sinuses. Material and methods. 6 patients with osteomas of paranasal sinuses were included in the group, mean age 36 years (range 15-52). Most common involvement was ethmoid cells (3). There were also patients with frontal, maxillary and sphenoid osteoma. All tumours were removed under endoscopic giudance. Frontoethmoidectomy was performed to remove ethmoid and frontal osteomas. Antrotomy was used in case of maxillary involvement and sphenoethmoidectomy in the patient with sphenoid sinus osteoma. Sphenoid sinus was approached through its anterior wall with a Stammberger punch. All the tumours were removed using fine forceps. Results. No post-operative complications were observed. No recurrences were noted. All patients remain asymptomatic. Conclusions. Resection of small and medium size osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects.

Association of paranasal sinus osteoma and intracranial mucocele--two case reports.

Two young adult males presented with paranasal sinus osteoma associated with mucocele. A 20-year-old man presented with headache and seizure, and another 20-year-old man presented with headache, frontal deformity, and visual disturbances. Both patients underwent surgery and satisfactory results were obtained. Isolated paranasal sinus osteomas are benign and slow-growing tumors, but may become more aggressive in association with mucoceles. The higher aggressiveness of the lesions may be due to the presence of the mucocele. Calcification and ossification of the mucocele probably contributes to the unexpected enlargement of the osteoma.

Osteomas de senos paranasales: revisión de 14 casos

ObjectiveTo present our experience in the management of paranasal sinus osteomas Material and methodsWe review 14 patients with frontoethmoidal osteomas removed in our hospital between 1988-2001. The initial symptoms, site and size of the lesions, surgical approaches and short and long term complications were assesed ResultsThe most common symptom in our serie was headache (57%); most of the tumors were located in frontal (35%) and frontoethmoidal (35%) regions with a mean size of 4,2 cm (maximum diameter) at the time of surgery. All symptomatic osteomas were resected by classic external surgical approaches but two cases were removed by endonasal surgery DiscussionAlthough osteomas are bening tumors, they may enlarge progressively and produce complications. Their resection is not free of risks, so there is some controversy about the management of asymptomatic patients. Endonasal surgery reduces the morbidity of the treatment but the location and size of the lesions do not allow to employ this technique in all cases

Surgery of frontal sinus osteoma

Frontal sinus osteomas are 57% of all paranasal sinus osteomas, with an incidence of 00.1 to 3%. Surgical removal of the frontal sinus osteomas is done in symptomatic patients. Asymptomatic patients can be managed conservatively or submitted to surgery in spite of its location or extension. Five patients having the diagnosis of frontal sinus osteoma were operated on between 1995 and 1999. Medium age was 38.4 years (from 12 to 55 years), 3 male and 2 female. Symptoms occurred from 6 months to 3 years, average of 10.5 months. Four patients had previous headache and one had epistaxis. All patients had standard radiological exams and computed tomography with coronal and axial studies of paranasal sinus. In two patients the diameter of the osteoma was larger than 3 cm and in three smaller than 3 cm. The choice between coronal and supraciliar approach was made according to esthetics, supraciliar approach was made in only one bald patient even with the tumor being large and extending to ethmoidal sinus. Any intra operative difficulty was related to the choice of the approach. Naso-frontal ostium was not obstructed in intra operative course. Minimal postoperative follow up was of two years. Osteomas were radically removed in all patients with no recurrence or residual tumor. Clinical findings, radiological exams and surgical approaches are discussed. No postoperative complications occurred.

Endoscopic removal of paranasal sinus osteoma: A case report

Osteomas are the most common benign tumors of the paranasal sinuses.1 The origin of these tumors has been ascribed to embryologic tissue maldevelopment, trauma, or infection.2 Paranasal sinus osteomas can also be seen in Gardner’s syndrome, characterized by intestinal polyposis and bone and skin lesions. Histologically, osteomas are composed of compact and/or cancellous-type mature bone, with vascular or connective tissue components. They grow very slowly and grossly appear as hard, lobulated masses.1 In the decreasing order of frequency, they are seen in the frontal, ethmoidal, and maxillary sinuses. The usual presentation is as an asymptomatic incidental finding on plain or computed tomography (CT) scans. Facial pain, nasal obstruction, proptosis, facial asymmetry, and headache are the most common symptoms. The treatment is surgical excision. The timing of surgery and the type of approach (external vs endoscopic) are controversial.

Frontal sinus osteoma associated with cerebral abscess formation: a case report

BACKGROUND Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. We present an unusual case of a frontal sinus osteoma leading to intracerebral abscess formation. CASE DESCRIPTION A 51-year-old Hispanic man presented with increasing frontal headaches, new onset seizure, lethargy, global dysphasia, and unilateral hemiparesis. CSF studies demonstrated mild pleocytosis. Neuroradiological studies revealed an opacity filling the left frontal sinus, as well as a ring-enhancing mass with surrounding edema in the left frontal lobe. The patient was surgically treated with a left frontal osteoplastic craniotomy and removal of the abscess and bony mass. Intraoperative cultures were positive for Streptococcus pneumoniae. Pathology revealed bony tumor consistent with osteoma. The patient’s neurological status improved to baseline after surgery. CONCLUSION The frontal sinus osteoma was associated with rapid development of a frontal lobe abscess, requiring emergent surgical debridement. Although rare, intracerebral manifestations should be considered and expected as a cause of new neurological deficits in the presence of paranasal sinus osteoma.

内視鏡下鼻内手術で摘出し得た前頭洞骨腫例

The incidence of paranasal sinus osteoma is highest in the frontal sinus, but only a few cases of frontal osteoma have been reported in the Japanese literature. We report a case of frontal osteoma removed by endoscopic endonasal surgery.The patient was a 74-year-old female who complained of f rontalgia of unknown origin. We made the diagnosis of frontal osteoma based on the X-ray and CT findings. The tumor was small enough to be removed by endoscopic endonasal surgery. We concluded that surgery is one choice of treatment, even for asymptomatic frontal osteomas, when they can be removed by endonasal surgery.

Huge osteoma of the frontoethmoidal sinus with secondary brain abscess

Osteomas of paranasal sinuses are usually asymptomatic. When enlarged, they may cause serious complications. We report a case of huge frontoethmoidal osteoma associated with brain abscess. If an osteoma associated with an intracerebral pathology is detected, it should be remembered that this could have been a complication of the osteoma and a detailed radiological examination should be performed to show the extent of the osteoma and to confirm any defect at the posterior wall of the sinus which may lead intracerebral complications. Such an osteoma should be operated after the abscess was resolved and patient became stable neurologically.

Orbital extension of a frontal sinus osteoma in a thirteen-year-old girl

Osteomas are uncommon, slow-growing, benign osteogenic neoplasms that arise most frequently in the craniofacial skeleton. 1,2 Osteoma is the most common benign tumor of the nose and paranasal sinuses and the most common neoplasm of the frontal sinus. 3–5 Paranasal sinus osteomas originate in the sinus wall, fill the lumen with well-defined mature osseous tissue, and occasionally extend into the orbit where they give rise to orbital signs and symptoms. Osteomas most commonly become symptomatic in the second to fifth decade in life, but orbital involvement has rarely been reported in patients aged 18 years and younger. 2,6–10 We report a case of a frontal sinus osteoma with orbital extension in a 13-year-old girl.

Paranasal sinus osteomas: a review of 46 cases.

In a survey of 1500 coronal sinonasal CT scans, 46 patients were found to have paranasal sinus osteomas. The overall incidence was 3%, with a predilection for decades 5 and 6 and a male-to-female ratio of 1.3:1. The frontal sinus was most commonly involved, and of these lesions 37% were in the immediate vicinity of the nasofrontal duct and 21% above and lateral to the ostium. Tumour size varied from a mean diameter of 1.5 mm to 30 mm; however, 17 lesions were 5 mm in size or less. Five matrix patterns were observed. Only two patients were symptomatic and only three osteomas excised. Isotope bone scanning may be a useful screening test with specific follow-up utilising computed tomography.