Ethmoid Osteoma as a Culprit of Orbital Emphysema

Abstract

Orbital emphysema is generally recognized as a complication of orbital fractures involving any paranasal sinuses. The recognition about its etiology has extended beyond sole trauma, but few articles mentioned tumors to be a possible cause.In this case report, we present a patient with orbital emphysema associated with ethmoid osteoma without orbital cellulitis or trauma history. The patient developed sudden proptosis, eyelid swelling, and movement limitation of the left eye, peripheral diplopia, and left periorbital crepitus after a vigorous nose blowing.Complete surgical resection of ethmoid osteoma followed by repair of the orbital medial wall was performed with assistance of combined endoscopy and navigational techniques. Twelve-month follow-up showed no residual lesion or recurrence; the orbital medial wall was accurately repaired with good visual function and facial symmetry.Tumors should be considered for differential diagnosis of orbital emphysema, and combined endoscopy and navigational techniques may improve safety, accuracy, and effectiveness of orbital surgeries.

Orbital cellulitis secondary to giant sino‐orbital osteoma: A case report

“…The first category is the result of pressure effect of the tumor including proptosis, orbital pain, diplopia, decrease in visual acuity, palpable mass and epiphora. The second category includes clinical findings secondary to sinusitis which may be the result of obstruction or damage to the involved sinus and presenting as orbital emphysema, orbital cellulitis and subperiosteal abscess formation adjacent to the involved sinus 2‐6,8 . The orbital extension of the infection in some reports was suggested that occurred via the bony erosion of the tumor and involvement of the orbital periosteum 5,9 .…”

“…The second category includes clinical findings secondary to sinusitis which may be the result of obstruction or damage to the involved sinus and presenting as orbital emphysema, orbital cellulitis and subperiosteal abscess formation adjacent to the involved sinus. [2][3][4][5][6]8 The orbital extension of the infection in some reports was suggested that occurred via the bony erosion of the tumor and involvement of the orbital periosteum. 5,9 On the other hand, an intact periosteum has been shown in cases of orbital invasion of infection, suggesting that the sinus contents may gain access to the orbit not only via the emissary vessels and nerves but also through the paper like thin medial wall of the orbit.…”

“…The latter, based on the site and extension of the orbital involvement, may produce proptosis, diplopia, visual complaints and epiphora 1‐3 . Orbital emphysema and cellulitis have been rarely reported after extension of osteoma to the orbit 2,4‐6 …”

“…[1][2][3] Orbital emphysema and cellulitis have been rarely reported after extension of osteoma to the orbit. 2,[4][5][6] Herein we report a case of orbital cellulitis secondary to orbital extension of a giant ethmoidal osteoma, which was treated with a combination of endoscopic and external approach in addition to systemic antibiotics.…”

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

“… 39 Alotaibi describes the case of an osteoma of the anterior ethmoidal cells sized 30 × 25 × 15 mm growing in the direction of the orbit, which was excised endoscopically using neuronavigation, as in the case of the tumour sized 30 × 20 × 15 mm described by Zhuang. 12 , 36 Endoscopic excision of osteomas from the ethomoid cells is recommended, but insufficient when the lesions spread outside the sinuses. 40 Karbassi draws attention to the cases, described in the literature, of giant osteomas in the ethomoid region removed endoscopically, which were not accompanied by orbital complications.…”