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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 46-47

Huge Ethmoidal Osteoma With Extensive Intraorbital Extension: A Case Report


1 Department of Otorhinolaryngology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India
2 Department of Surgical Oncology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India
3 Department of Anaesthesia, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, India

Date of Web Publication12-Feb-2016

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  Abstract 


Osteoma is a benign, slow-growing osteoblastic lesion. It is the most common benign tumor of the sinonasal tract. The frontal sinus is the most frequently involved anatomic site followed by the ethmoid, the maxillary sinus, and, more rarely, the sphenoid sinus. As osteomas are usually asymptomatic, they are very often incidental radiographic findings. Giant osteomas of the paranasal sinuses are rare but readily extend into the intraorbital or intracranial cavity, causing serious complications. A rare case of large ethmoidal osteoma in a 34 year old male with extensive intraorbital involvement is being discussed.

Keywords: Osteoma, Ethmoid, Orbit


How to cite this article:
Singh RK, Sinha R, Pankaj S, Raghvendra K H, Mishra S. Huge Ethmoidal Osteoma With Extensive Intraorbital Extension: A Case Report. J Indira Gandhi Inst Med Sci 2016;2:46-7

How to cite this URL:
Singh RK, Sinha R, Pankaj S, Raghvendra K H, Mishra S. Huge Ethmoidal Osteoma With Extensive Intraorbital Extension: A Case Report. J Indira Gandhi Inst Med Sci [serial online] 2016 [cited 2022 Oct 2];2:46-7. Available from: http://www.jigims.co.in/text.asp?2016/2/1/46/303374




  Introduction: Top


Osteoma is a benign, slow-growing osteoblastic lesion. It comprises of 3% of all benign paranasal sinuses tumours with peak incidence between the fourth and sixth decades[1]. It mostly involves frontal sinuses, followed by the ethmoid, the maxillary sinus, and more rarely, the sphenoid sinus[2]. Histologically, it is similar to normal bone. Due to presence of varying amounts of fibrous tissue, it occurs as cortical osteoma or less dense as cancellous osteoma. It can be congenital or acquired secondary to trauma or infection[3]. It is usually asymptomatic and diagnosed incidentally on radiography[2]. Giant osteoma of the paranasal sinuses are rare but readily extend into the intraorbital or intracranial cavity, causing serious complications. A rare case of large ethmoidal osteoma in a 34 year old male with extensive intraorbital involvement is being discussed.


  Case Report: Top


A 34-year-old male presented with history of hyposmia, diplopia and ptosis of the right eye for past 4 years. There were no associated symptoms, such as epistaxis, rhinorrhea, diminished vision or nasal obstruction. He had no history of surgery or trauma. An endoscopic examination revealed smooth protuberance of upper lateral wall of right nasal cavity. The nasopharynx, other part of nasal cavity and rest of the ENT examination were within normal limit. The systemic and haematological examination was also found normal. Computed tomography (CT) revealed a multilobulated 5.0 x 4.5 cm mass of osseous density occupying the right ethmoid sinus that extended into the right orbit and base of the right frontal sinus [Figure 1]. The lesion had displaced the lamina papyracea medially, while the orbital globe was displaced laterally, inferiorly and in forward direction. On the basis of these findings the diagnosis of right sided ethmoidal osteoma with orbital extension was made. The lesion was removed by Lynch Howarth approach. The extension of lesion was reassessed. The lesion was removed by partial drilling and manipulation with periosteal elevator. The specimen was send for histopathological examination that revealed bony trabeculae and loose fibrocollagenous stroma, predominantly cortical bone without cytological atypia, which was a classic feature of osteoma [Figure 2]. The wound was closed in layer. The stitches were removed on 7th post-operative period. The ocular examination was done periodically, which was returned within the normal limit in 10th post-operative period. There was no recurrence found during a follow-up period of 2 years.
Figure 1: Computed tomography (CT) revealed a multitabulated 5.0×4.5-cm mass of osseous density occupying the right ethmoid sinus that extended into the right orbit

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Figure 2: H&E stain 40Xmagnification showing bony trabeculae and loose fibrocollegenous stroma.

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  Discussion: Top


Craniofacial osteoma are benign tumours often originating in the paranasal sinuses. The exact aetiology is unknown. Apart from postulated post-traumatic or infectious origin, they are thought to arise during embryologic development[3]. The peak incidence is between the fourth and sixth decades, with male preponderance[1],[4]. It is a slow- growing, encapsulated bony tumour which is mostly asymptomatic, very often incidental radiographic finding (in 1% of plain sinus radiographs or in 3% of sinus computerised tomographic scans)[5],[6].

Osteoma often lead to sinusitis due to blockage of the ostia and mucocele formation common in frontal sinus. But the presentation can be sometimes atypical such as when there is orbital or intracranial invasion. Huge ethmoidal osteoma invade the orbit and cause proptosis and restricted ocular motility. This case presented with a giant osteoma of ethmoid with orbital invasion and proptosis. Diagnosis is based on radiological examination showing localised, isolated, markedly radio dense lesions of the paranasal sinuses. It was first used in the diagnosis of osteoma in 1899[6]. It can present as an expansile lesion with or without orbital or intracranial extension. This differentiates osteoma from other bone tumours like fibrous dysplasia, ossifying fibroma which have less well defined borders.

Surgical excision is the treatment of choice for symptomatic cases and for cosmosis. The approach depends on location and extent of spread. Asymptomatic cases do not require any treatment. They can be followed radiographically. The anterior orbital lesions can be removed via an anterior orbitotomy, while the posterior ones require an orbitocranial procedure[6]. Our case had a huge orbito-ethmoidal osteoma causing severe proptosis, and after endoscopic intranasal ethmoidotomy, there was complete restoration of eyeball movement and position. Recurrence of these tumours is rare.

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  References Top

1.
Alotaibi N, Hanss J, Benoudiba F,et al. Endoscopic removal of large orbito-ethmoidal osteoma in pediatric patient: Case report. International Journal of Surgery Case Reports 2013; 4:1067-70.  Back to cited text no. 1
    
2.
Yiotakis I, Eleftheriadou A, Giotakis E, et al. Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty. World Journal of Surgical Oncology 2008; 6:110.  Back to cited text no. 2
    
3.
Trinidade A, Shakeel M, Moyes C, et al. The Evidence- based Management of Bilateral Ethmoid Osteomas: Diagnosis, Endoscopic Resection and Review of the Literature. West Indian Med J 2010; 59:188-91.  Back to cited text no. 3
    
4.
Bertoletti F, Capolunghi B, Bertolini G et al. Giant osteoid osteoma of ehtmoid sinus: role of functional endoscopic sinus surgery. Acta Otorhinolaryngol 2004; 24:297-301.  Back to cited text no. 4
    
5.
Sar?M, Baglam T, Yaz?c?ZM. Endoscopic removal of frontoethmoid osteoma: a rare case report. Marmara Medical Journal 2005;18:39-42.  Back to cited text no. 5
    
6.
Yucel A, Acar M, Haktanir A, et al. De?irmenci Orbital Extension Of A Large Frontal Sinus Osteoma Associated With Fibrous Dysplasia. Eur J Gen Med 2004; 1:74-77.  Back to cited text no. 6
    


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