Nguyen Sally, Nadeau Sylvie
1 Department of Ophthalmology and Otolaryngology - Head & Neck Surgery, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
2 Department of Otolaryngology and Head & Neck Surgery, CHU de Québec - Hôpital de l'Enfant-Jésus, Quebec City, Quebec, Canada.
Am J Rhinol Allergy. 2019 Jan;33(1):36-43. doi: 10.1177/1945892418804911. Epub 2018 Oct 11.
Osteomas are rare benign and slow-growing osteogenic tumors mainly involving frontal and ethmoid sinuses.
The primary objective of our study is to present the management of cases of giant frontal sinus osteomas. Secondarily, we describe our modified unilateral osteoplastic flap approach without obliteration to remove these osteomas.
Retrospective chart review at a tertiary academic center ("Hôpital de l'Enfant-Jésus") from July 2006 to October 2016. Demographics characteristics, tumor characteristics, presenting symptoms, frontal sinus surgery technique (osteoplastic flap, endoscopic surgery, or a combination of both), and outcomes of giant frontal sinus osteomas (≥30 mm) were recorded. For laterally placed osteomas, tumors with posterior wall involvement, orbital roof involvement, or intracranial extension, the modified unilateral osteoplastic flap approach was used. A decision-making algorithm is proposed for the choice of surgical approach.
Ten giant frontal osteomas were analyzed (7 men and 3 women). The mean age at diagnosis was 38 years old (range, 24-55 years; median, 39 years; standard deviation, 11 years). The most common presenting symptom was headache (43% of symptomatic patients). Five patients had complications preoperatively due to tumoral extension (sinusitis, cellulitis, mucocele, optic nerve compression, and convulsions). One patient was treated endoscopically, 3 patients had an open approach and 6 patients had a combined technique. One patient experienced a postoperative complication (local infection treated with oral antibiotics). Six patients had minimal residual tumor with one patient needing reoperation.
Osteomas are rare paranasal sinus tumors. Due to the proximity to noble structures, a giant frontal osteoma should be managed surgically. The modified unilateral osteoplastic flap without obliteration offers good long-term surgical and aesthetic results. Osteomas are not known for malignant transformation and recurrences are rare; thus, subtotal resection is warranted and safe when a cleavage plan is not found.
骨瘤是罕见的良性、生长缓慢的成骨性肿瘤，主要累及额窦和筛窦。
本研究的主要目的是介绍巨大额窦骨瘤病例的治疗方法。其次，我们描述了不进行填塞的改良单侧骨成形瓣入路来切除这些骨瘤。
对2006年7月至2016年10月在三级学术中心（“圣婴耶稣医院”）进行回顾性病历审查。记录人口统计学特征、肿瘤特征、临床表现、额窦手术技术（骨成形瓣、内镜手术或两者结合）以及巨大额窦骨瘤（≥30mm）的治疗结果。对于位于外侧的骨瘤、累及后壁、眶顶或有颅内扩展的肿瘤，采用改良单侧骨成形瓣入路。提出了一种手术入路选择的决策算法。
分析了10例巨大额骨瘤（7例男性，3例女性）。诊断时的平均年龄为38岁（范围24 - 55岁；中位数39岁；标准差11岁）。最常见的临床表现是头痛（43%有症状的患者）。5例患者术前因肿瘤扩展出现并发症（鼻窦炎、蜂窝织炎、黏液囊肿、视神经受压和惊厥）。1例患者接受内镜治疗，3例患者采用开放入路，6例患者采用联合技术。1例患者术后出现并发症（口服抗生素治疗局部感染）。6例患者残留肿瘤极少，1例患者需要再次手术。
骨瘤是罕见的鼻窦肿瘤。由于靠近重要结构，巨大额骨瘤应采用手术治疗。不进行填塞的改良单侧骨成形瓣入路可提供良好的长期手术和美学效果
