Endoscopic Endonasal Removal of Ethmoido-orbital Osteoma with Optic Nerve Compression

Introduction:Osteoma is the most frequent benign tumour of the nose and paranasal sinuses. It is a rare and usually slow-growing osteogenic neoplasm. It is often originates in the frontal and ethmoid sinuses, much less frequently in the maxillary and sphenoid sinuses. The initial symptoms, such as headache and facial pain, are delayed and non-specific. The tumour commonly grows asymptomatically and being an incidental finding in 1% of plain sinus radiographs and 3% of computed tomographic scans of the sinus. Orbital extension is a rare event that can give rise to ocular signs and symptoms; in such a case treatment is mandatory, although debate persists regarding the optimal approach. Open procedures for removal of ethmoid osteomas have been the method of choice, but optimal treatment is controversial

Material and Method :We report a total resection of large ethmoido-orbital osteoma via endoscopic endonasal approach with minimal morbidity and no cosmetic deformity. A 19-year-old women presented with a 2 mounths history of progressive proptosis, right fasial headache and diplopia. Imaging studies showed a large bony mass in right ethmoid sinus extending into the right orbit. The tumor had compressed and slightly diverted the optic nevre . The tumor was totally removed via endoscopic endonasal aproach and a multilayer reconstruction was applied to the inferomedial wall of the orbit without any complications.

Results :Patient was reported a gradual regression of syptoms which are totally disapeared after a 4 month follow up.

Conclusions :Symptomatic paranasal sinus and orbit osteomas were being operated via open approaches previously, but today endoscopic endonasal aproaches are considered to be a safe and effective alternative procedure with cosmetic advantages and low morbidity.