Frontoethmoidal and Intraorbital Osteomas

Abstract

The size of the osteoma, far lateral extension of the tumor in the frontal sinus beyond the lamina papyracea, and intraorbital involvement are no longer absolute contraindications for purely transnasal endoscopic resection. What is important is that the surgeon should not be dogmatic but rather be ready to change his or her mind during surgery, shifting to an external approach when required.

Comprehensive review on endonasal endoscopic sinus surgery

“…If the surgeon is very experienced, even very large tumors penetrating the whole frontal sinus, sometimes also with insertion in front or superiorly can be removed endonasally via frontal sinus drainage type III [grade III-IV osteomas according to [ 1001 ]; [ 999 ], [ 1004 ], [ 1009 ], [ 1010 ], [ 1011 ], [ 1012 ]. Precondition is a suitable anatomy whereby the interorbital distance [ 1011 ] and the ratio of anterior-posterior diameter of the frontal sinus opening to the total size of the frontal sinus [ 1012 ] are of high relevance. Improved instruments and devices, e.g.…”

“…Improved instruments and devices, e.g. powerful curved drills, help to shift the limits of endonasal surgery step-by-step [ 1011 ], [ 1012 ]. Obviously the most important limitation is the growth in frontal direction into the anterior wall with the probable necessity of reconstruction [ 1011 ].…”

“…In the individual case, any dogmatism with regard to certain types of approach is inappropriate. Decision making has to be performed on an individual basis [ 1012 ].…”

“…Because of the benign nature of the tumor and its unknown or often missing growth, leaving small residues is preferred to a complete resection if it is associated with a significant increase of the morbidity. After resection of intraorbital osteomas, a reconstruction of the lamina papyracea is not necessary if the periorbit remains intact or has only small-sized lesions [ 1012 ], [ 1015 ]. Only in cases of larger, however, not exactly quantified defects, reconstruction is indicated to avoid diplopia.…”

Osteomas of the nose and paranasal sinuses: A review of literature

“…Подчеркивается, что размер опухоли, крайне латеральное и/или интра орбитальное ее распространение больше не являют ся абсолютными противопоказаниями для трансна зального эндоскопического доступа [37]. A. Chiu и соавт.…”