Ahmed Ahmed Nabil Abdelhamid, Elsharnouby Mohamed M, Elbegermy Marwa Mohamed
Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, 11331, Egypt.
Eur Arch Otorhinolaryngol. 2023 Feb;280(2):743-756. doi: 10.1007/s00405-022-07564-8. Epub 2022 Jul 28.
Nasal sinus cholesteatomas are uncommon slow-growing lesions that are frequently misdiagnosed preoperatively. They can develop due to embryologic remnants or iatrogenic factors (surgical trauma or nasal sinus trauma). In addition, they can cause bone destruction resulting in intracranial or intraorbital complications as well as malignant change if neglected. Complete surgical removal is a must with strict postoperative follow-up.
Three cases of nasal sinus cholesteatoma are reported. The first case was found inside the ethmoidal sinus, the second in the frontal sinus, and the third was found inside a concha bullosa. In all three cases, a wide endoscopic surgical excision was performed. Due to the lateral extension of the lesion, frontal sinus trephine was also used in the case of frontal sinus nasal cholesteatoma. In addition, a review of the English literature for the reported cases of nasal sinus cholesteatomas was conducted.
There were no reported recurrence or residual during strict postoperative follow-up for 2 years (by endoscopic examination and diffusion-weighted MRI with delayed postcontrast T1 images). A review of the English literature revealed 42 cases of nasal sinuses cholesteatomas (including the present three cases) (17 in the frontal sinus, 15 in the maxillary sinus, 5 in the ethmoid sinus, 3 in the sphenoid sinus, and 2 in a concha bullosa).
Although nasal sinus cholesteatomas are uncommon, they must be considered in the differential diagnosis of slow-growing nasal sinuses lesions. Preoperative CT scan and diffusion-weighted MRI are essential for proper diagnosis and to exclude other similar lesions, such as nasal sinus mucoceles, cholesterol granuloma, or neoplastic lesions. Wide complete surgical excision is necessary to avoid recurrence and facilitate postoperative follow-up. As with ear cholesteatoma, strict postoperative follow-up is required to detect recurrence or residual early and is performed by endoscopic examination, diffusion-weighted MRI, and delayed post-gadolinium T1 images.
鼻窦胆脂瘤是一种罕见的生长缓慢的病变，术前常被误诊。它们可因胚胎残余或医源性因素（手术创伤或鼻窦创伤）而发生。此外，如果忽视，它们可导致骨质破坏，引发颅内或眶内并发症以及恶变。必须进行完整的手术切除并严格术后随访。
报告3例鼻窦胆脂瘤病例。第一例位于筛窦内，第二例位于额窦，第三例位于泡状鼻甲内。所有3例均行广泛的内镜手术切除。由于病变向外侧扩展，额窦胆脂瘤病例还采用了额窦环钻术。此外，还对英文文献中报道的鼻窦胆脂瘤病例进行了回顾。
在严格的术后2年随访期间（通过内镜检查以及延迟增强T1图像的扩散加权磁共振成像），未报告复发或残留情况。对英文文献的回顾显示有42例鼻窦胆脂瘤（包括本研究的3例）（17例位于额窦，15例位于上颌窦，5例位于筛窦，3例位于蝶窦，2例位于泡状鼻甲）。
尽管鼻窦胆脂瘤并不常见，但在鉴别诊断生长缓慢的鼻窦病变时必须考虑到。术前CT扫描和扩散加权磁共振成像对于正确诊断以及排除其他类似病变（如鼻窦黏液囊肿、胆固醇肉芽肿或肿瘤性病变）至关重要。广泛完整的手术切除对于避免复发和便于术后随访是必要的。与耳胆脂瘤一样，需要严格的术后随访以早期发现复发或残留，通过内镜检查、扩散加权磁共振成像和钆剂增强后延迟T1图像进行。
