Giant Paranasal Sinus Osteomas

Abstract

Giant paranasal sinus osteomas are rare tumors that may be very closely adherent to surrounding anatomical structures, and complete removal of these tumors may be very challenging. We report 6 cases of giant paranasal sinus osteomas that were removed completely and discussed their symptoms, diagnostic workup, and our surgical approach. We reviewed the patient files of our 6 cases with giant paranasal osteomas and summarized their history, symptoms, diagnosis, management, and follow-up. Three of our patients underwent endoscopic sinus surgery; the other 2 patients underwent open surgical approach (osteoplastic flap procedure with bicoronal incision), and 1 patient underwent both endoscopic and open approaches, all under general anesthesia. Mean patient age was 42.6 years (range, 18-54 years). Main symptoms were headache, proptosis, and diplopia. Physical examination findings include proptosis and frontal puffiness. Paranasal sinus computed tomography revealed larger than 3-cm-diameter tumors in the frontal and ethmoid sinuses. The surgical approach to each case was customized to the location, size, and presenting symptoms of the osteoma. Histopathology revealed osteoma in all cases. All patients were evaluated with paranasal sinus computed tomography scan postoperatively. At a mean follow-up of 15 months, complication was observed in 1 patient; no residual tumor or recurrence was detected following surgery. In symptomatic cases with huge tumors, open, endoscopic, or combined approaches could be applied because of the location and size of the tumor with successful outcomes. Both endoscopic and open approaches are safe and effective methods for removal of these tumors.

Endoscopic Excision of Rare Large Maxillary Sinus Osteoma: A Case Report and Literature Review

“…Paranasal sinus osteomas are mostly asymptomatic, being detected accidentally on paranasal computed tomography (CT) scans. About 4% to 10% of them cause clinical symptoms related to the location, size, and growth features of the tumor, including facial deformity, swelling, facial pain, nasal discharge, nasal obstruction, headache, chronic sinusitis, orbital symptoms (proptosis, epiphora, diplopia, visual loss), and cerebral complications (dizziness, meningitis, pneumatocele, brain abscess, cerebrospinal fluid leakage) [4,5,7]. Rarely, extensive growth could determine aesthetic or functional problems that vary according to different locations [14].…”

“…Paranasal sinus osteoma incidence has been reported to be around 3%, of which maxillary sinus osteomas represent only 5%. They are commonly detected in the fourth decade of life, with a male predominance [4,7]. According to Mlouka et al, in the case of a maxillary sinus osteoma, the lesion usually appears on the lateral wall of the sinus [15]].…”

“…In the present case, this theory could be supported by the fact that the patient presented concomitant chronic rhinosinusitis. However, none of the theories adequately explains the developmental mechanism; thus, further research is needed [4,7].…”

“…Moreover, a small osteoma is technically easier to remove than a larger one, with lower complication rates. In addition, surgical treatment should be performed immediately for sphenoid sinus osteomas because of the potential severe visual and intra-cranial complications [7]. Surgical excision of symptomatic osteomas, using an appropriate surgical approach, remains necessary according to the localization of the tumor, the subsequent symptomatology, and patient age, regardless the size of the osteoma [4,11].…”

“…In symptomatic cases with huge tumors, open, endoscopic, or combined approaches could be applied, with successful outcomes. Surgical approaches should be customized for each patient and total resection should be the operative goal [2][3][4][5][6][7]. Surgical resection of some big osteomas of the paranasal sinuses could also be performed safely and radically by endoscopic techniques with a better outcome [8].…”