Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport.
Department of Otolaryngology, Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, CA.
Perm J. 2020;24. doi: 10.7812/TPP/19.048. Epub 2020 Feb 14.
Cholesteatomas are lined by squamous epithelium, contain keratin debris, and can cause bony erosion. Although commonly found in the middle ear space and mastoid, cholesteatomas may develop in adjacent structures including the paranasal sinuses. Frontal sinus cholesteatoma (FSC) is a rare condition with fewer than 30 reported cases. The aims of this study are to describe the clinical presentation, diagnostic imaging, and endoscopic treatment of FSC and to review the literature focusing on the pathogenesis, diagnosis, and historical and contemporary treatments of FSC.
A 45-year-old man presented with a 1-week history of right eyelid and forehead swelling. Results of computed tomography scans and magnetic resonance images revealed a right frontal sinus lesion of soft-tissue density with bony dehiscence along the superior orbit and posterior table. He underwent right-sided endoscopic sinus surgery at a tertiary care center in January 2017. Intraoperatively, the frontal sinus contained keratin debris suggestive of FSC. This suspicion was confirmed postoperatively by pathologic analysis after subtotal resection.
The pathogenesis of frontal sinus cholesteatoma varies based on its cause (congenital vs acquired). Clinical diagnosis remains challenging but is aided by nasal endoscopy, computed tomography, and magnetic resonance imaging. Historically, FSC has been managed by total extirpation through open approaches, which can entail substantial morbidity. With sophisticated endoscopic sinus instrumentation and image guidance, FSC can be successfully treated via an endoscopic approach. Serial débridements and washouts in an outpatient setting may adequately manage the residual disease in the postoperative period.
胆脂瘤由鳞状上皮构成，含有角蛋白碎片，可引起骨质侵蚀。尽管胆脂瘤通常在中耳腔和乳突中发现，但也可在相邻结构中发展，包括副鼻窦。额窦胆脂瘤（FSC）是一种罕见的疾病，报道的病例少于 30 例。本研究的目的是描述 FSC 的临床表现、诊断影像学和内镜治疗，并回顾文献，重点关注 FSC 的发病机制、诊断以及历史和当代治疗。
一名 45 岁男性因右眼睑和前额肿胀 1 周就诊。计算机断层扫描和磁共振成像结果显示右侧额窦病变为软组织密度，眶上缘和后颅窝骨质缺损。他于 2017 年 1 月在一家三级护理中心接受了右侧内镜鼻窦手术。术中，额窦内含有角蛋白碎片，提示 FSC。术后经大体标本分析证实了这一怀疑。
额窦胆脂瘤的发病机制因病因（先天性与后天性）而异。临床诊断仍然具有挑战性，但鼻内镜、计算机断层扫描和磁共振成像有助于诊断。历史上，FSC 通过开放式手术进行完全切除，这可能会带来很大的发病率。随着复杂的内镜鼻窦仪器和图像引导的发展，FSC 可以通过内镜途径成功治疗。在门诊环境中进行定期清创和冲洗可能足以在术后处理残留疾病。
