gms | German Medical Science

83rd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

16.05. - 20.05.2012, Mainz

Unusual giant Ethmoid-Frontal Osteoma – 2 clinical cases

Meeting Abstract

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 83rd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Mainz, 16.-20.05.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12hno53

DOI: 10.3205/12hno53, URN: urn:nbn:de:0183-12hno536

Published: July 23, 2012

© 2012 Rebelo van Schaik et al.
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Outline

Text

Introduction: Ethmoidal osteoma with growth into the orbita or change of the facial contour lines are rare. After surgical removal of these massive osteomas with diffuse growth, reconstructive measures may be needed.

Material and methods: We present 2 patients with massive growth of osteomas in the ethmoid or frontal cells.

Results: Case 1: A 40-year old patient complained about frontal headaches, hyposmia and epiphora. A tumor in the right middle meatus was recognizable in the nasal endoscopy. A CT-scan showed a sclerosed tumor in the right ethmoidal cells with protrusion into the internal orbital wall. A biopsy concluded for a spongiform osteoma. Because of the extension, the osteoma was removed through a combined approach. The periorbita remained untouched and was reinforced with the use of a plate. The tear canal was spared. The frontal ostium had to be enlarged. The resulting bone defect was smaller than expected. After 6 months the patient had no complaints, except for the already existing hyposmia.

Case 2: a 21-year old patient complained about frontal headaches and a growing subcutaneous tumor in this area. 4 years earlier she went through endonasal surgery for nasal polyposis. A CT-scan revealed a massive osteoma in the ethmoid and frontal sinuses which didn’t spare the nasion and frontal wall of the frontal sinus. The skin was bulged above the nasal root. The osteoma was completely removed through a bi-coronal incision. The frontal wall of the frontal sinus had to be removed, with obliteration of the sinus. The facial contour change is to be corrected with a 3-D implant through the same incision.

Conclusion: In the treatment of giant osteomas, the functional and anatomical aspects are extremely important. Some esthetical changes may appear or the function of the sinus system or other neighboring structures such as the orbita or tear canal can be affected. The reconstruction of these structures plays a remarkable role when planning the surgical treatment.


References

1.
Dubin, MG, Kuhn FA. Preservation of Natural Frontal Sinus Outflow in the Management of Frontal Sinus Osteomas, Otolaryngology. Head and Neck Surgery. 2006 Jan;134(1):18-24.
2.
Georgalas C, Goudakos J, Fokkens WJ. Osteoma of the skull base and sinuses. Otolaryngol Clin North Am. 2011 Aug;44(4):875-90, vii.