gms | German Medical Science

Frontal sinus osteoma is one of the most common benign tumors of paranasal sinuses. Mostly small size osteomas are asymptomatic. Depending on a size and a localization osteoma can lead to such symptoms as a pain or to some complications from nasal obstruction up to meningitis. Removal can be endoscopic, external or mixed combination of approaches.

Endoscopic approach has some limitations and difficulties. Contraindications for endonasal removal reduce from year to year. First limitation is personal surgeon experience. Endoscopic frontal sinus osteoma removal is one of the most difficult procedures in ESS. Other limitations are lateral osteoma position, huge size of the tumor (giant osteoma). But evolution of methods and instruments can also reduce these limitations. Some difficulties can be detected intraoperatively, that’s why patient must be informed about a possibility of external approach in case endoscopic procedure will not be effective.

We would like to discuss such technical difficulties during osteoma removal, as tumor becomes mobilized inside sinus space. This can happen when osteoma arises on the roof of frontal bulla. In order to remove such mobile osteoma surgeon needs to perform a wide window, destruct tumor inside sinus or to apply external approach.

In ENT Clinic of First Pavlov State Medical University of Saint Petersburg we use surgical laser for intrasinual osteoma destruction.

During last two years 10 frontal sinus osteomas were removed endoscopically. Laser was applied successfully in 3 cases. Intrasinual laser-assisted osteoma destruction prevents a wide window formation so soft tissues and bony structures preserve intact.

No complications were observed. Our experience shows the perspectives of laser application in FS osteoma removal

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