Gil-Carcedo L M, Gil-Carcedo E S, Vallejo L A, de Campos J M, Herrero D
Department of Otolaryngology, Rio Hortega Hospital, Valladolid University Hospital, Valladolid University, Spain.
J Laryngol Otol. 2011 Oct;125(10):1020-7. doi: 10.1017/S0022215111001563. Epub 2011 Jul 18.
We believe the currently accepted indications for frontal osteoma surgery are inappropriate. We propose a new osteoma classification system, below, in order to standardise surgical decisions.
Osteomas were classified based on: relationship of tumour mass to sinus size; tumour proximity to the infundibulum, destruction of sinus walls, and complications. Forty-five osteoma cases were thus classified (1971-2007), 29 of which underwent surgery (64.44 per cent).
Three stages were thus derived: I, tumour/air fraction less than one-third, tumour distant from the infundibulum, no sinusitis, and no complications (18 patients (40 per cent)); II, tumour/air fraction one-third to one-half, no infundibular obstruction, no bone destruction, no sinusitis, and no complications (six (13.33 per cent)); and III, tumour/air fraction more than one-half, partial or total infundibular obstruction, sinusitis, bone destruction, and/or complications (21 (46.67 per cent)).
Study findings suggest the following surgical indications: stage I, no surgery required, implement monitoring protocol; stage II, implement monitoring protocol, surgery may be required depending on tumour severity and general patient condition; and stage III, surgery always required. This system provides a method of standardising osteoma surgical decisions.
我们认为目前公认的额骨骨瘤手术适应症并不恰当。我们提出了一种新的骨瘤分类系统，如下所述，以便规范手术决策。
根据以下因素对骨瘤进行分类：肿瘤大小与鼻窦大小的关系；肿瘤与漏斗部的距离、鼻窦壁的破坏情况以及并发症。对45例骨瘤病例（1971 - 2007年）进行了分类，其中29例接受了手术（64.44%）。
由此得出三个阶段：I期，肿瘤/气腔比例小于三分之一，肿瘤远离漏斗部，无鼻窦炎且无并发症（18例患者（40%））；II期，肿瘤/气腔比例为三分之一至二分之一，无漏斗部阻塞，无骨质破坏，无鼻窦炎且无并发症（6例（13.33%））；III期，肿瘤/气腔比例大于二分之一，部分或完全漏斗部阻塞、鼻窦炎、骨质破坏和/或并发症（21例（46.67%））。
研究结果提示以下手术适应症：I期，无需手术，实施监测方案；II期，实施监测方案，根据肿瘤严重程度和患者一般情况可能需要手术；III期，总是需要手术。该系统提供了一种规范骨瘤手术决策的方法。
