Ethmoid Sinus Osteoma Presenting as Epiphora and Orbital Cellulitis

Share Embed


Descrição do Produto

SURVEY OF OPHTHALMOLOGY VOLUME 43 • NUMBER 5 • MARCH–APRIL 1999

CLINICAL PATHOLOGIC REVIEW DAVID APPLE AND MILTON BONIUK, EDITORS

Ethmoid Sinus Osteoma Presenting as Epiphora and Orbital Cellulitis: Case Report and Literature Review AHMAD M. MANSOUR, MD, HAYTHAM SALTI, MD, SAMI UWAYDAT, MD, ROLA DAKROUB, MD, AND ZIAD BASHSHOUR, MD

Department of Ophthalmology, American University of Beirut, Beirut, Lebanon Abstract. Paranasal sinus osteoma is a slow-growing, benign, encapsulated bony tumor that may be commonly asymptomatic, being detected incidentally in 1% of plain sinus radiographs or in 3% of sinus computerized tomographic scans. In a patient presenting with orbital cellulitis and epiphora, computed tomography disclosed a large osteoma of the ethmoid sinus. Excision of the osteoma allowed recovery of vision, return of extraocular muscle function, and resolution of choroidal folds. Proptosis, diplopia, and visual loss are other frequent presenting signs of paranasal osteomas. Epidemiology, diagnosis, treatment, and pathologic findings in paranasal sinus osteoma are reviewed. (Surv Ophthalmol 43:413– 426, 1999. © 1999 by Elsevier Science Inc. All rights reserved.) Key words. choroidal folds • mucocele • nasolacrimal duct obstruction • orbital cellulitis • ossifying fibroma • osteoblastoma • osteogenic sarcoma

Osteomas of the paranasal sinuses cause various problems by producing pressure on neighboring structures. Of primary interest to the rhinologist, osteomas may extend by their slow and progressive growth into the domain of the ophthalmologist and the neurosurgeon. Previously, small sinus osteomas passed unnoticed, only to be discovered on autopsy. If larger and invading the orbit, they result in proptosis and ocular motility problems. Radiography now allows us to establish the presence of sinus osteomas, determine their extent, and appreciate the complications they may produce. We describe a patient with osteoma of the ethmoid sinus who presented with tearing and developed orbital cellulitis. We review the literature on paranasal osteomas and their ophthalmic complications.



osteoma

Case Report PRESENTATION AND CLINICAL COURSE

A 66-year-old woman came to the emergency unit with severe periorbital swelling, red eye, and the inability to move the right eye of 1 day’s duration. She had epiphora of 2 weeks’ duration, which had been diagnosed by an ophthalmologist as a right nasolacrimal duct obstruction. She had a temperature of 101.38F. The right eye had moderate exophthalmos, complete ptosis, and conjunctival chemosis (Fig. 1). The eye was in an exotropic position with complete underaction of the right medial rectus and severe underaction of the other extraocular muscles. A firm, elastic, 0.5-cm mass was palpated in the upper inner angle of the right orbit. Visual acuity was 6/12, 413

© 1999 by Elsevier Science Inc. All rights reserved.

0039-6257/99/$19.00 PII S0039-6257(99)00004-1

414

Surv Ophthalmol 43 (5) March–April 1999

MANSOUR ET AL

Fig. 1. Preoperative appearance of patient with right exophthalmos and inflamed right orbit.

with normal intraocular pressure and unremarkable fundus findings. Complete blood cell count revealed leukocytosis (27,400 white blood cells/mm3). Blood cultures grew coagulase-negative staphylococci. Computerized tomography (CT) of the orbits revealed a 3.1 3 2.7-cm, well-defined, markedly radiodense lesion arising from the right ethmoid sinus (Fig. 2). The mass had displaced the lamina papyracea, the right medial rectus, and the intracanalicular portion of the right optic nerve. A small soft-tissue mass in the supramedial aspect of the right orbit was consistent with a mucocele. A second bony lesion measuring 1 cm in diameter was present at the ostium of the left frontal sinus (Fig. 3). Both maxillary sinuses were opaque, and mucosal disease was present in the other sinuses. The patient was started on intravenous ceftazidime for orbital cellulitis and sinusitis. The initial diagnosis was benign osteoma with sec-

Fig. 2. Axial CT demonstrates a multilobulated 3.1 3 2.7cm, homogeneous, very radiodense lesion occupying the ethmoid sinus and pushing on the posterior orbital structures.

ondary orbital cellulitis, with the possibility of a sarcomatous transformation of the bony lesion. The fever subsided after initiation of antibiotic therapy. The proptosis increased, and visual acuity decreased to the finger-counting level. Choroidal folds involved the entire posterior pole, with edema of the optic disk and dilation of the retinal venous system. Endoscopic intranasal biopsy of the bony mass (consistent with a benign osteoma) was followed by total excision of the right ethmoidal mass via a lateral rhinotomy approach. Intraoperatively, the osteoma was seen to abut the lacrimal sac. The ethmoidal mass measured 3.5 3 2.5 3 2.5 cm. Microscopically, it consisted of dense mature bone with a small peripheral rim of cancellous bone (Fig. 4). Three weeks postoperatively, the patient recovered her preoperative visual acuity, with resolution of proptosis, ptosis, and motility limitation (Fig. 5). DISCUSSION

This case of bilateral paranasal sinus osteoma was symptomatic on the right side and had an atypical presentation of epiphora and staphylococcal orbital cellulitis. The patient had an orbital mucocele and sinusitis. The osteoma compressed the nasolacrimal duct, causing tearing. Medical therapy controlled the infection, and the progressive compression of the globe responded to surgical intervention. This histologically benign osteoma assumed a clinically aggressive behavior. Fig. 3. Coronal CT demonstrates the multilobulated nature of the right ethmoidal mass with small regions of variable radiodensity amid a very radiodense lesion. A small contralateral lesion of comparable radiodensity to the ethmoidal lesion is situated at the ostium of the frontal sinus and measures 1 cm in diameter.

Historical Background In 1941 Teed reviewed the early history of sinus osteomas.120 Bony growths of the skull had been described for hundreds of years (e.g., as “horned men”). Bony tumors of the paranasal sinuses were

415

ETHMOID SINUS OSTEOMA, EPIPHORA, AND ORBITAL CELLULITIS

Fig. 4. Ivory, compact-type osteoma. Note trabeculae with scanty vascular connective tissue matrix.

first described in 1506 by Veiga, who described a woman with a tumor the size of a hen’s egg in the superomedial orbit. The mass caused exophthalmos and facial deformity. The patient’s vision and appearance returned to normal after the tumor was removed in pieces. Vallisnieri in 1733 described an osteoma of the frontal sinus extending into the frontal lobe of the brain in a skull from a museum in Florence, Italy. The first illustration of an osteoma pushing the left globe laterally was presented by Hilton in 1836.120 In 1880 Knapp described subperiosteal enucleation of an ivory exostosis of the frontal sinus, extending into the nasal and orbital cavities.66 Bony tumors of the frontal sinus have long been recognized in domestic animals, particularly in ruminants, and may bear some relation to the hornforming tendency. In 1865 Paget described “a great spheroidal mass of ivory measuring 8.5 inches in diameter and weighing upwards of 16 pounds” occurring in an ox; the specimen is in the Museum of the Royal College of Surgeons of England (pathology specimen No. 3216).5

Fig. 5. Postoperative appearance 3 weeks after excision of the osteoma. There is marked resolution of the proptosis and ptosis.

A frontal sinus osteoma was found in a human skull fossil dating back to the diluvial period (glacial age).65 Another voluminous frontal sinus osteoma was found in the skull of a skeleton dating to the eighth century that was exhumed from the Napoleon Square at the Louvre, France.14

Epidemiology SEX

Teed reviewed 321 cases of paranasal osteomas reported before 1940 and found 172 in males and 93 in females (male to female ratio of 1.85).120 We reviewed 567 cases reported after 1939 and, in the reports that stated patient sex, found 280 males versus 174 females (male to female ratio of 1.6). The greater preponderance of sinus osteomas in men is attributed to men’s greater exposure to trauma and the larger size of their sinuses.3 AGE

In Teed’s 321 cases, age ranged from 13 to 75 years, with a mean of 46.4 years.120 In our review of cases, ages ranged from 4 years41 to 82 years,83 with a mean age of 37.8 years. This decrease in mean age after 1939 reflects earlier presentation, improved radiologic diagnosis, and somewhat earlier surgical intervention (i.e., age is often reported as the age at time of surgery). In 1950 Begley and Hallberg reported the average age at presentation to be 26 years for ethmoidal sinus osteomas and 39 years for frontal sinus osteomas,10 and attributed earlier presentation in ethmoid lesions to the cramped space of the ethmoid sinus, thus, the earlier appearance of symptoms. In the 75 most recently published cases of paranasal os-

416

Surv Ophthalmol 43 (5) March–April 1999

teomas, we did not find any significant difference in age of presentation according to location (34.5 years for 46 frontal osteomas; 31.2 years for 13 ethmoid osteomas; 33.6 years for 11 maxillary osteomas; and 31.4 years for five sphenoid osteomas). The age at onset of first symptoms is usually in the third and fourth decades.120 The time period from diagnosis to surgery seems shorter in more recent cases, although most reports did not give this information. In the cases reported before 1940, 10 cases were operated on more than 20 years after presentation, with one case operated on 45 years after presentation.120 A 1969 article by Mortada reported the average time between presentation and surgery to be less than 7 years.81 RACE

All races have been affected by paranasal osteomas worldwide. Incidences in various groups have been reported: blacks from USA,79 Egypt,81 and Nigeria87; Indians3; Orientals67; Hispanics77; and whites from Australia,22 Europe,31 Israel,68 Lebanon,127 Siberia,37 and USA.66,96–98,126 There is no known predilection for any race. INCIDENCE BASED ON RETROSPECTIVE REVIEW OF CLINICAL RECORDS

Incidence of Sinus Osteomas According to Garretson, in 1861 Knapp found four osteomas of the paranasal sinuses among the records of 56,000 patients (an incidence of 71.4 per million).41 Teed found two cases of frontal sinus osteomas among 48,000 patients admitted to one hospital in Ann Arbor, Michigan, between 1918 and 1939 (an incidence of 41.7 per million).120 In 1940 Handousa found 18 osteomas among the records of 840,000 patients attending an Ear-Nose-Throat Department (an incidence of 21.4 per million).50 Among 12,500 admissions to the Neurosurgery Department of the Radcliffe Infirmary in Oxford between 1939 and 1968, Bartlett found six patients with frontoethmoid osteomas and associated intracranial complications (an incidence of 1 of 2,000 neurosurgery admissions), and 14 other frontoethmoidal osteomas admitted to other services in the same period.8 Incidence of Ocular Involvement of Sinus Osteomas Secondary invasion of the orbits by osteomas is relatively uncommon, with an incidence of 0.9% to 5.1% of all orbital tumors. Reese96,98 found one sinus osteoma among 109 orbital tumors (0.92%), Benedict12 found 38 among 740 orbital tumors (5.1%), Forrest38 found five among 184 orbital tumors (2.7%), and Eldrup-Jorgensen34 found four among 263 (1.5%). Brihaye et al18 reported osteoma of the paranasal sinuses to account for 2.3% of exophthalmos cases

MANSOUR ET AL

caused by tumors. Zacharia et al127 found one osteoma among 85 cases of unilateral exophthalmos. We reviewed the records of patients with the diagnosis of paranasal osteomas at the American University of Beirut from 1980 to 1996 and found no cases of ocular involvement. Andrews found eight orbital osteomas among the records of 429,989 cases seen at three major ophthalmic institutes in New York City (an incidence of 18.6 per million).26 INCIDENCE OF SINUS OSTEOMAS BASED ON RADIOGRAPHIC STUDIES

In studies of sinus radiographs, Childrey found 15 osteomas in 3,510 (0.427%),23 Eckel and Palm found 64 in 16,000 (0.4%),62 and Mehta and Grewal found 50 in 5,086 (1%).76 Schertel detected radiographically 25 paranasal osteomas in one medical center over a period of 16 months.106 Earwaker found 46 osteomas among 1,500 coronal CT scans (an incidence of 3%), with only two patients being symptomatic and three patients undergoing surgery.32

Clinical Characteristics of Sinus Osteomas SITE

According to a review of the literature before 1929,37 the most frequent sites of origin were the frontal (50%), ethmoid (40%), maxillary (6.2%), and sphenoid (3.6%) sinuses. In our review of 567 cases reported after 1939, we found the frontal sinus to be by far the most common site (71.8%), followed by the ethmoidal sinus (16.9%), maxillary sinus123 (6.3%), and sphenoid sinus78,121 (4.9%) (Tables 1 and 2). An exceptional case of ivory osteoma arising from the palatine bone and growing into the orbit was described by de Lemos and Pinto according to Duke-Elder.30 GROWTH PATTERNS

The rate of growth of osteomas is considered to be slow, with most authors reporting no growth over periods ranging from 12 to 30 years (average follow-up of 18.8 years).5,8,15,116 In a study of shorter duration, no change was found in four paranasal osteomas followed up for 1 to 3 years. In another study, 30% growth was found over 9 years.47 Although a large number of osteomas remain asymptomatic, many osteomas grow and become symptomatic (Table 3). Initially, the osteoma takes the form of the paranasal sinus in which it originates, and with increasing size it invades adjacent orbital and intracranial cavities. Growth can occur in incompletely excised osteomas. Thomas reported a patient in whom an osteoma, nine months after inadequate removal, had regrown larger than the original tumor.44 In another case, a tumor regrew rapidly during 2 years after incomplete excision of a frontal osteoma.112 Roy reported a

417

ETHMOID SINUS OSTEOMA, EPIPHORA, AND ORBITAL CELLULITIS TABLE 1

Distribution of Osteomas of the Paranasal Sinuses According to Site in Case Series of Four or More Patients No. of Osteomas

First Author Fetissof37 Childrey23 Handousa50 Smith112 Benedict11 Dowling29 Newell83 Hallberg47 Begley10 Colver24 Andrew2 Rowbotham101 Pool92 Mehta76 Zonis128 Soboroff113 Mortada81 Bartlett8 Samy104 Fu39 Miller79 Boysen15 Atallah6 Earwaker32 Detsouli28 Weber124 Total

Year

Frontal

Ethmoid

Maxillary

Sphenoid

1929 1939 1940 1940 1941 1945 1948 1950 1950 1951 1956 1957 1962 1963 1966 1966 1969 1971 1971 1974 1977 1978 1981 1993 1995 1995

3 10 20 1 13 5 4 40 40 6 5 4 21 48 15 5 3 4 10 13 25 19 20 37 10 15 396 (75.1%)

1 1 7 3 4 0 2 9 9 0 0 1 0 1 0 1 7 1 4 1 7 4 1 9 0 0 73 (13.9%)

0 1 6 1 3 0 0 2 2 0 0 0 0 1 0 0 0 0 6 15 4 2 2 0 0 0 45 (8.5%)

0 0 1 0 9 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0

16-year-old girl with excision of a large orbital osteoma of ethmoidal origin followed 8 years later by recurrence of the osteoma with intracranial extension and formation of a large frontal abscess.102 SIZE

Giant sinus osteomas have been reported7,79 but are rare.91 The heaviest osteomas reported weighed 1,285,45 587,9,30 and 442 grams.120 Osteomas can oc-

13 (2.5%)

Total 4 12 34 5 29 5 7 51 51 6 5 5 21 50 15 6 10 5 21 30 36 25 23 46 10 15 527

cupy one half of one hemisphere and project considerably over the forehead, nose, and eye, as occurred in a specimen reported by Paget, which is exhibited in the Museum at Cambridge.5 A frontal sinus osteoma measuring 12.5 3 12 3 12.5 cm is exhibited in the Warren Museum at Harvard Medical School (pathology specimen No. 1464). Arnold presented a paranasal osteoma measuring 9 3 7.5 3 7 cm according to Armitage.5

TABLE 2

Clinical Characteristics of Osteoma According to Sinus Location Location

Incidence Shape Growth Proptosis Involves first Fatality

Frontal

Ethmoid

Sphenoid

Maxillary

71.3% (Most common) Lobulated Slow Downward and outward Cranial cavity

17.1% (Common) Pedunculated Relatively rapid Outward only

5.1% (Rare) Variable Variable Outward

6.5% (Rare) Variable Variable Upward and outward

Orbit

Optic nerve

Rare

Rare

Fatal if untreated

Lacrimal passages and infraorbital nerves No

418

Surv Ophthalmol 43 (5) March–April 1999

MANSOUR ET AL TABLE 3

Growth Pattern of Paranasal Sinus Osteomas First Author

Perod of Growth (yrs)

Age at Onset (yrs)

Site

Remarks

Atallah

35

8

Maxillary

Sadry32* Spencer116 Teed120 Rappaport93

15 10 17 7

NA 43 13 70

Frontal Frontal Frontal Frontal

Pfeiffer90

5

44

Ethmoid

Newell83

5

10

Sphenoid

Resulted in visual loss; presented with proptosis Grew 5 times the original size Had acromegaly Grew fast after 7 years of slow growth Resulted in pneumatomucocele; had yellow nail syndrome Increased 3 times the original size after initial 2 years of stagnation Radiographic growth noted over 4-month period, resulted in death 5 years after start of growth

6

NA 5 not available. *According to Earwalker32

SHAPE

The majority of osteomas assume a smooth and knobby surface. Osteomas of the ethmoid sinus frequently assume a mushroom shape (Fig. 6).79,97 Frontal osteomas have also been described as cauliflowershaped5 and dumbbell-shaped.104 Tamari and Weisman

compared the ramifying characteristics of the osteoma through the ethmoid cells to the pseudopodia of the amoeba.118 Osteomas can be multiple within the sinus,70 or a single osteoma can involve the contralateral sinus or multiple paranasal sinuses on the same side, generally assuming a multilobulated shape.1,4,17,35,82,115

Fig. 6. Diagram of a coronal sinus radiogram showing an ethmoidal osteoma (black) impinging on the globe and entering the cranial cavity and associated with a large mucocele (shaded area). The osteoma was successfully excised by the transfrontal approach by Cushing in 1927 (adapted from Cushing26).

419

ETHMOID SINUS OSTEOMA, EPIPHORA, AND ORBITAL CELLULITIS NONOCULAR SYMPTOMS

The most common symptom of a paranasal osteoma is headache localized over the area of the osteoma.82 Headache may be intermittent24,29 and exacerbated by flying.29 Periorbital headache can be evoked on certain gazes,4,79 maximal upon awakening,84 and lancinating.88 Fenton reported a patient with a well-defined nasociliary neuralgia that resolved after excision of a small osteoma of the frontal sinus, which was impinging on the anterior ethmoidal nerve.36 Small osteomas obstructing the drainage pathways may cause a vacuum headache similar to that experienced with barotrauma.69 Other nonocular symptoms include frontal deformity, rhinorrhea, anosmia,122 and decreased concentration (Table 4).122 Although symptoms are generally related to the size of the osteoma and its location, exceptions have been noted. Small osteomas have been reported to cause severe headache and necessitate surgical excision,24 whereas massive osteomas of the ethmoid sinus may remain asymptomatic.118 OCULAR FINDINGS

The ocular findings in sinus osteomas are listed in Table 5. The most common findings, in decreasing order of frequency, are proptosis, extraocular muscle displacement, optic disk edema, choroidal folds, and orbital infection. The proptosis is tender, nonpulsating, nonreducible, noninflamed, and without detectable bruit. In severe proptosis, conjunctival chemosis and exposure keratitis may be present. Frontal sinus osteomas cause protrusion of the eye forward, downward, and

TABLE 4

Central Nervous System and Rhinologic Complications in Paranasal Sinus Osteomas Common complications Mucocele55,110,122 Sinusitis from sinus occlusion Pneumatocele8,20,24,26,57,92,93,101,119 Sensory motor disturbances Rare complications Brain abscess55,110 Anosmia122 Mental disorders (mental confusion,47 amnesia,47 decreased concentration122) Epilepsy51 Vertigo Cerebrospinal rhinorrhea Dizziness24 Meningitis14 Internal hydrocephalus79 Obstruction to breathing116

outward, whereas ethmoidal lesions push the eye forward and outward, and maxillary lesions push the eye upward and outward. Bartlett described a 35year-old farmer who complained initially of the “sun getting into his eyes” secondary to a lateral and downward displacement of the globe from a right frontal sinus osteoma.8 Enophthalmos has also been reported in a case of frontal sinus osteoma that grew down from the supraorbital ridge.107 Extraocular muscle displacement by paranasal sinus osteomas presents a diplopia. Because of the location, the superior oblique muscle is often stretched. Occasionally, the trochlea is eroded113 or a Brown syndrome is present.13 External ophthalmoplegia occurs secondary to orbital cellulitis22,26,101,112,119,120 or orbital apex syndrome.119 Visual loss occurs when the globe is markedly compressed by the enlarging osteoma, resulting in disk edema, ophthalmic vein compression, and choroidal folds. Variable degrees of optic atrophy de-

TABLE 5

Ocular Findings in Paranasal Sinus Osteomas (in Decreasing Order of Frequency) Common findings Exophthalmos Extraocular muscle displacement Choroidal folds Optic disk edema From direct compression by the osteoma11,89 Secondary to brain abscess126 Secondary to intracranial mucocele72 Secondary to pneumatocele24 Secondary to increased intracranial pressure5,83 Orbital cellulitis22,26,101,116,119,120 Optic disk atrophy53,78 Nasolacrimal duct obstruction44,83,99,117,126 Hyperesthesia of the frontal region/numbness of supraorbital region/nasociliary neuralgia30,82 Rare findings Eyelid edema89 Eyelid ptosis42 Narrowing of palpebral fissure107 Amaurosis fugax84,126 Dacryocystitis79 Palpebral abscess79 Compression of superior ophthalmic vein2,119 Orbital apex syndrome119 Central retinal vein occlusion119 Acquired Brown syndrome13 Orbital emphysema22 Mydriasis84 Enophthalmos83 Spasm of accommodation83 Eyelid fistula104 Eyebrow fistula10 Erosion of trochlea112 Corneal ulcer3

420

Surv Ophthalmol 43 (5) March–April 1999

MANSOUR ET AL TABLE 6

Cases of Orbital Cellulitis with Sinus Osteoma First Author 26

Cushing Cecire22 Andrew2 Taptas119 Teed120 Smith112 Rowbotham101

Age (yrs)

Site

41 17 60 40 22 16 39

Ethmoid Ethmoid Frontoethmoid Frontoethmoid Frontal Frontal Frontal

velop in untreated cases. Blindness is unilateral and results from spread of the tumor and destruction of the eye, direct pressure on the optic nerve84 and interference with the ocular blood supply, or infection. Large tumors may completely destroy the eye.2 Primary bilateral optic atrophy leading to total blindness from sphenoid sinus osteoma has been reported.53 Other ocular findings include shooting retrobulbar pain and transient visual disturbance.2 Cases have been reported in which progressive unilateral amaurosis was the only clinical sign of sinus osteoma.84,126 Several cases of papilledema have been described secondary to direct tumor compression12,83 or a brain abscess,126 or from internal hydrocephalus.2 Seven cases of orbital cellulitis (Table 6) and seven cases of nasolacrimal duct obstruction (Table 7) have been described. Lid edema89,126 and ptosis42,126 may be among the early manifestations of osteomas. Spasm of accommodation and hyperesthesia of the frontal region may be caused by a frontal osteoma invading the medial orbit.83 Palpebral abscess in the context of frontal sinusitis and dacryocystitis has been reported.79 Orbital emphysema was described in association with an ethmoid sinus osteoma,22 and unilateral mydriasis from orbital apex syndrome was recorded in a sphenoid sinus osteoma.84

Remarks/Complications None Orbital emphysema, recurrent orbital cellulitis Pneumococcal meningitis Central retinal vein occlusion None None None

Etiology Genetic factors may play a role in the development of osteomas, as in Gardner syndrome,40 an autosomal condition characterized by intestinal polyps, multiple hamartomas of the retinal pigment epithelium, pigmented skin lesions, and multiple osteomas. In Gardner syndrome, osteomas involve preferentially the skull and maxillary sinus and can be demonstrated by panoramic radiography.48 Five paranasal osteomas associated with Gardner syndrome have been reported, and these osteomas are of the multiple variety, involving preferentially the ethmoid sinus and the mandible.6,16,59,60,125 The vast majority of osteomas are of unknown cause and would perhaps be regarded in many cases as osseous hamartomas.79 Three theories have been advanced for the etiology of osteomas; infectious,29,92 traumatic,43,95 and developmental (Table 8). Sinusitis may stimulate osteoblastic proliferation within the sinus mucoperiosteum, leading to tumor formation. Despite the coexistence of sinusitis with osteoma, some authors believe the sinusitis results from occlusion of sinus openings by the osteoma. Trauma during puberty, when bone development is at its maximum, has been implicated in several cases of osteoma. Childrey reported a frontal sinus osteoma secondary to a well-documented injury.23

TABLE 7

Cases of Nasolacrimal Duct Obstruction With Sinus Osteoma First Author 44

Gibson Sternberg117 Wilkes126 Wilkes126 Newell83 Rizzutti99 NA = not available.

Age (yrs)

Sinus

Comments

NA 15 NA NA 22 74

Frontal Ethmoid NA NA Ethmoid Ethmoid

— Failure of dacryocystorhinostomy — — — Surgical excision of osteoma successful in relieving nasolacrimal duct obstruction

421

ETHMOID SINUS OSTEOMA, EPIPHORA, AND ORBITAL CELLULITIS TABLE 8

Theories for the Pathogenesis of Frontal Osteoma19 First Author

Year 19

Cruveilher Virchow19 Dolbeau19 Arnold5 Fetissof 37 Gardner40 von Ganz19 Aegerter62 Broniatowski19

Theory

1856 1865 1871 1873 1929 1953 1960 1963 1984

Expanding cystic bony formation Fibrous neoformation of medullary origin Mucoperiosteal origin Embryologic origin at membrane-endochondral junction Periosteal split of main tissue through early trauma or infection Genetic origin Endocrinologic origin Osteogenic hamartoma (exaggeration of intramembranous bone formation) Metaplasia of persistent osteogenic cells under initial negative pressure and low-grade inflammation Three-Step Consensus Theory (Synthesis of Our Literature Review) Step 1—Embryology: Two tissues of different embryologic origin are brought in contact (cartilaginous bone of the nasal capsule is covered by the membranous bone of the face). Step 2—Puberty and Growth: During the first two decades of life, pneumatization occurs and continues in the clefts between cartilaginous and membranous bones. Step 3—The Trigger (Trauma/Infection): Fracture or chronic sinusitis stimulates osteoid activity, leading to osteoma formation.

Rawlings elicited a history of facial trauma in six (20%) of 29 patients with maxillary sinus osteoma.95 However, no history of trauma was found in other series.126 In favor of the developmental theory is the fact that many osteomas appear to arise at the junction of the ethmoid and frontal sinus, a location where membranous and cartilaginous tissues meet during embryonic life.126 Cohnheim proposed that tumors arise frequently at the site of contact of two tissues of different embryonic origin according to Pool et al92 and Wilkes.126 Some authors believe that no part of the skeleton is more prone to osseous hypergenesis than the orbit, where so many bones are so intimately related (frontal, maxilla, lacrimal, os planum, sphenoid, and palatine).12 During embryogenesis, the cartilaginous bone of the nasal capsule is covered by the membranous bone of the face. It is in the clefts between the cartilaginous and membranous bones that pneumatization occurs and continues actively during the first two decades of life, and here, under the stimulus of a chronic sinus infection or an unsuspected fracture, the cells are stimulated into osteogenic activity.26,30

Computerized tomographic scanning demonstrates the point of attachment to the sinus wall (around 24% of osteomas have an identifiable pedicle) and the posterior extent of the mass.54,103,106 The density of the mass depends on the amount of ivory and cancellous bone in the tumor. Earwaker observed five matrix patterns by CT: uniformly sclerotic, targetlike, partially corticated shells with heterogeneous matrix, heterogeneous matrix without well-defined shells, and laminated.32 High signal intensity on T2weighted MR imaging confirms the presence of an associated mucocele.115 Spiral CT helps to give a three-dimensional reconstruction of the tumor, but its use has not been illustrated yet in paranasal osteomas. Radionuclide bone scan can help to differentiate an actively growing lesion (“hot”) from a stable lesion (“cold”).86 Orbital venography has been used to demonstrate compression of the superior ophthalmic vein.3 A cancellous osteoma was found to be vascular by intravenous angiography,33 whereas ivory osteomas were noted to be avascular.100

Diagnosis

In older reports, mortality after surgery for sinus osteomas was very high because of the absence of radiographs, absence of aseptic techniques, primitive anesthesia, and a high postoperative infection rate in the preantibiotic era. The mortality has dropped from 28.6% between 1850 and 1874, to 6.5% between 1870 and 1900, and to 0% between 1900 and 1905.41 Initial attempts involved taking one piece of the osteoma at a time, necessitating several surger-

Since its first use in the diagnosis of osteomas in 1899,85 radiography has become the method of choice for diagnosis of osseous lesions. Osteomas are easily demonstrated by plain radiographs, CT, or magnetic resonance (MR) imaging as localized, isolated, markedly radiodense lesions resting on the floor of the sinus and expanding the involved sinus with or without orbital or intracranial extension.54,73

Surgery HISTORY OF SURGERY

422

Surv Ophthalmol 43 (5) March–April 1999

ies, or chiseling the hard osteoma itself.5,41,120 Later it was found that it was easier to cut the surrounding bones, which leads to rocking and dislodging of the osteoma. Cushing was the first to use the transfrontal approach to remove osteomas.26 Patterson and Cairns were the first to use the nasoorbital approach to remove an orbital osteoma.89 Newell reported that radiotherapy failed to stop the progression of an osteoma, 83 but Priest and Boies reported stabilization of the tumor with radiotherapy according to Duke-Elder.30 CURRENT APPROACHES TO SURGERY

Indications for Surgery Generally, osteomas are treated conservatively. No treatment is recommended for asymptomatic osteomas, especially in elderly subjects.73 Asymptomatic paranasal sinus osteomas without intracranial or orbital extension or cosmetic deformity should be followed up with periodic radiographs to determine a change in size. Sphenoid osteomas, however, should be removed immediately, because the slow progressive growth may ultimately compress the visual pathways, causing blindness.53,97 Rarely, osteomas undergo a spontaneous cure after a severe infection.1 As sinus osteomas are frequently found in asymptomatic patients, firm guidelines for surgical intervention are necessary (Table 9). Surgical Techniques The surgical approach must protect the vital structures, while optimizing the ability to totally excise the osteoma with minimal cosmetic deformity.2,21,52, 75,91,94,105,128 For ethmoid osteomas, an external incision around the medial canthus is used. This incision can be extended superiorly to gain exposure of the frontal sinus or inferiorly converting into a lateral rhinotomy. The external approach over the frontal sinus provides the most direct route with an attempt at preserving the superior orbital rim.6 Approaches for sphenoid sinus osteomas may be trans-

TABLE 9

Indications for Surgery in Paranasal Osteomas56,62,63,105 All sphenoid osteomas, irrespective of size Presence of significant symptoms Unexplained headache Recurrent sinusitis Ocular symptoms Central nervous system symptoms Enlargement seen radiographically Extension beyond the confines of the sinus Filling of more than 50% of the volume of the frontal sinus Location near the frontal sinus ostium Cosmetic deformity

MANSOUR ET AL

septal, subnasal midline, transpalatal, and transorbital transpalatal.78 Huge osteomas of the orbit can be managed in one stage by orbital osteotomy, followed immediately by reconstruction of the resulting bony defects with a free vascularized bone graft.67,108 Some small frontal, ethmoid and sphenoid sinus osteomas can be removed completely via the endonasal route, with use of a microscope and an endoscope.25,77,109,124 In well-selected cases, endoscopic sinus surgery offers a convenient, safe, and effective alternative to open procedures, with reduced morbidity and superior cosmetic results.77 Carbon dioxide laser has been used successfully in one case of frontal sinus osteoma.68 Use of antibiotics, drainage of associated infection in the sinuses, and extirpation of associated mucoceles are necessary steps in the overall management of complications resulting from osteomas. In several reported cases, symptoms were related to the mucoceles which can be bigger than the osteoma70; in such cases, therapy is directed at relieving the mass effect of the mucoceles. Visual acuity usually improves after excision of the osteoma because of relief of mass effect on the globe, the optic nerve, and the venous drainage of the eye.46,104,119 Taptas et al reported visual improvement from 1/20 to 6/10 after excision of an osteoma causing central retinal vein occlusion.119 However, if optic atrophy is advanced, no postoperative visual improvement is noted.84

Pathology The histologic type of bone formation is compact, hard laminated (eburneous), spongy (cancellous), or a mixture of the two.94 With the exception of one case mentioned by Hallberg and Begley,47 in which sarcomatous change was revealed histologically after removal, all osteomas recorded represent benign growths.44 Malignant tumors of the frontal and ethmoidal sinuses are rare in contrast to the relatively more common malignancies arising from dental structures in the maxillary sinuses.41 The tumors are more or less encapsulated and, in most cases, there is a pedicle joining the tumor to the sinus. Detached pedicles, resulting in “dead osteomas” (or “spontaneous cure”), occasionally have been found in cadavers.41

Differential Diagnosis Based on Radiologic and Pathologic Features The radiologic and pathologic features of tumors included in the differential diagnosis of paranasal and orbital bony lesions are summarized in Table 10.11,27,39,61,64,71,74,111,112 Tumors fall into three main categories: neoplasms, fibroosseous disease, and reactive-reparative lesions. Exostoses are asymptomatic, exceedingly slow-growing nodules projecting from the surface of the bone. Hyperostoses are dif-

423

ETHMOID SINUS OSTEOMA, EPIPHORA, AND ORBITAL CELLULITIS TABLE 10

Differential Diagnosis of Paranasal and Orbital Bony Lesions27,49,54,58,61,64,71,74,111,113,114 Lesion Type

Radiologic Features

Neoplasms Osteoma Osteogenic sarcoma Osteoblastoma71

Pathologic Features

Well-defined, extremely radiodense “Sunburst” appearance

Mature, hard, or cancellous bone Haphazard osteoid and bone spicule arrangement (anaplasia) Central zone of edematous vascular fibrous tissue with scattered trabeculae of osteoid and bone and outer layer of dense, mature bone.113 Highly differentiated hyaline cartilage

Cystic bone lesion with sclerotic margin

Osteochondrome Fibro-osseous disease Fibrous dysplasia Ossifying fibroma51,74,111 Reactive-reparative lesions

Not applicable Homogeneous radiopaque lesions with irregular, poorly defined margins Same as fibrous dysplasia Varying degrees of bone destruction

Paget disease Giant cell granuloma

Irregular trabeculae of coarse woven bone with very cellular fibrous stroma with no osteoblasts Predominance of highly fibroblastic stroma with minor osseous deposition Reactive process (chronic inflammatory cells) Scattered multinucleated giant cells, fibroblastic-type stromal cells, hemorrhages, osteoid deposition, new bone formation Scattered multinucleated giant cells, little intercellular material, rare osteoid deposition

Giant Cell tumor Brown tumor Exostoses Hyperostoses

fuse thickenings of bone caused by chronic inflammation or neoplasms such as meningiomas11; there is preferential involvement of the sphenoid bone and roof of the orbit.

Conclusion The advent of diagnostic radiology in the 19th century changed the approach to management of sinus osteomas. The CT scan allowed further definition of the osteoma and facilitation of complete surgical removal. Osteomas are detected in 3% of CT scans performed for sinus evaluation, and about 5% of osteomas become symptomatic or require surgery. Treatment is indicated in sphenoid osteomas and in symptomatic osteomas elsewhere. Yearly radiographic follow-up is needed in asymptomatic lesions. Transorbital approach, direct sinus surgery, endonasal surgery, and frontal cranioplasty are the modalities available to excise the whole lesion, depending on its location and its impingement on the orbit or the cranium.

words “sinus osteoma,” and limited to English, French, and German (languages familiar to us). The references contained in these articles were also reviewed and were selected if they included ocular findings. Additionally, we checked the references of the references. Much of the information from cases reported before 1939 was obtained from a 1941 review article.120

References 1. 2. 3. 4. 5. 6.

Method of Literature Search

7.

Literature selection for this article was based on a MEDLINE search from 1966 to 1997, using the key

8.

Alaerts J: A propos de deux cas d osteome ethmoidofrontal. Acta Otorhinolaryngol Belg 26:294–302, 1972 Andrew J: Osteomata of the paranasal sinuses; a report of five cases, with special reference to their treatment. Br J Surg 43:489–497, 1956 Appalanarasayya K, Murthy AS, Viswanath CK, Devi OB: Osteoma involving the orbit: case report and review of literature. Int Surg 54:449–453, 1970 Ardouin M, Urvoy M, Eon JY, Le Clech G, Guegan Y: Expressions ophtalmologiques des osteomes des sinus de la face. Rev Otoneuroophtalmol 51:365–368, 1979 Armitage G: Osteoma of the frontal sinus, with particular reference to its intracranial complications, and with the report of a case. Br J Surg 18:565–580, 1931 Atallah N, Jay MM: Osteomas of the paranasal sinuses. J Laryngol Otol 95:291–304, 1981 Ataman M, Ayas K, Gursel B: Giant osteoma of the frontal sinus. Rhinology 31:185–187, 1993 Bartlett JR: Intracranial neurological complications of frontal and ethmoidal osteomas. Br J Surg 58:607–613, 1971

424 9.

10. 11. 12. 13. 14.

15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

Surv Ophthalmol 43 (5) March–April 1999 Beck JC: Some uncommon types of neoplasms about the head: osteomata of the frontal sinus; multiple myeloma; intrapalatal tumor. Trans Am Laryngol Otol Soc 36:374–386, 1930 Begley JW, Hallberg OE: Osteomas of the paranasal sinuses and their treatment. Proc Staff Meet Mayo Clinic 25:13–16, 1950 Benedict WL: Hyperostosis of the orbit. Am J Ophthalmol 24:1005–1013, 1941 Benedict WL: Surgical treatment of tumors and cysts of the orbit: the eleventh de Schweinitz lecture. Am J Ophthalmol 32:763–773, 1949 Biedner B, Monos T, Frilling F, Mozes M, Yassur Y: Acquired Brown’s syndrome caused by frontal sinus osteoma. J Pediatr Ophthalmol Strabismus 25:226–229, 1988 Bourry M, La Phung F, Pereira da Silva MA: Mise en evidence d un osteome du sinus frontal sur un crane provenant des fouilles archeologiques du vieux Louvre. Actual Odontostomatol 44:117–125, 1990 Boysen M: Osteomas of the paranasal sinuses. J Otolaryngol 7:366–370, 1978 Bregeat P, Hamard H: Une exophtalmie par osteome: A propos d un cas du syndrome de Devic-Bussy-Gardner. Arch Ophtalmol Rev Gen Ophtalmol 28:247–252, 1968 Bridger GP, Lindsay RA, Payten R: Osteoma involving multiple paranasal sinuses. Aust N Z J Surg 47:374–376, 1977 Brihaye E, Hoffman GR, Francois J: Les exophtalmies neuro-chirurgicales. Neurochirurgie 14:384–389, 1968 Broniatowski M: Osteomas of the frontal sinus. Ear Nose Throat J 63:267–271, 1984 Campbell EH, Gottschalk RB: Osteoma of frontal sinus and penetration of lateral ventricle, with intermittent pneumocephalus. JAMA 111:239–241, 1938 Cassady CL, Alexander FW: Removal of a large frontoethmoid osteoma. Arch Otolaryngol 93:81–82, 1971 Cecire A, Harrison HC, Ng P: Ethmoid osteoma, orbital cellulitis and orbital emphysema. Aust N Z J Ophthalmol 16:11–14, 1988 Childrey JH: Osteoma of sinuses, the frontal and sphenoid bone: report of fifteen cases. Arch Otolaryngol 30:63–72, 1939 Colver BN: Osteomata of the frontal sinus with special consideration of the surgical removal. Laryngoscope 61:341– 367, 1951 Coste A, Chevalier E, Beautru R, Abd Alsamad I, Salvan D, Peynegre R: Osteoma of the naso-sinusal cavities: surgical indications and role of endonasal endoscopic surgery. Ann Otolaryngol Chir Cervicofac 113:197–201, 1996 Cushing H: Experiences with orbito-ethmoidal osteomata having intracranial complications. Surg Gynecol Obstet 44: 721–742, 1927 Deshmukh SD, Kolhatkar MK: Ossifying fibroma, osteosarcoma and chondrosarcoma involving maxillary sinus, a report of 4 cases. Indian J Med Sci 36:97–100, 1982 Detsouli M, Laraqui NZ, Benghalem A, et al: Osteoma of the frontal sinus: a propos of 10 cases. Ann Otolaryngol Chir Cervicofac 112:293–297, 1995 Dowling JR: Osteoma of the frontal sinus: report of five cases. Arch Otolaryngol 41:99–108, 1945 Duke Elder SS: Textbook of Ophthalmology. London, Henry Kimpton, 1952, vol 5, pp 5596–5605 Duterme JP, Duchateau JP, Vanderkelen B: Sinusite frontale, abces palpebral et exophtalmie sur osteome. Acta Otorhinolaryngol Belg 45:315–318, 1991 Earwaker J: Paranasal sinus osteomas: a review of 46 cases. Skel Radiol 22:417–423, 1993 El-Naggar AM, El-Refaie AA: Rare causes of proptosis and their management. Bull Ophthalmol Soc Egypt 64:517– 523, 1971 Eldrup-Jorgensen P: Primary, histologically confirmed orbital tumors in Denmark 1943–1962: histologic and prognostic studies. Acta Ophthalmol 48:657–688, 1970 Ersner MS, Saltzman M: Osteoma of the sinuses. Laryngoscope 48:29–37, 1938

MANSOUR ET AL 36. 37. 38. 39.

40.

41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56.

57. 58. 59. 60. 61. 62. 63.

Fenton RA: Osteoma causing nasociliary neuralgia. Ann Otol Rhinol Laryngol 42:911–914, 1933 Fetissof AG: Pathogenesis of osteoma of nasal accessory sinuses. Ann Otol Rhinol Laryngol 38:404–413, 1929 Forrest AW: Intraorbital tumors. Arch Ophthalmol 41:198– 230, 1949 Fu Y-S, Perzin KH: Non-epithelial tumors of the nasal cavity, paranasal sinuses and nasopharynx: a clinicopathologic study. II. Osseous and fibro-osseous lesions including osteoma, fibrous dysplasia, ossifying fibroma, osteoblastoma, giant cell tumor, and osteosarcoma. Cancer 33:1289–1305, 1974 Gardner E, Richards RC: Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 5:139–147, 1953 Garrettson WT: Osteoma of the frontal, the maxillary and the sphenoid sinuses. Arch Otolaryngol 5:135–142, 1927 Gatewood WL: Osteoma of the frontal sinus: review of the literature and report of a case presenting extensive invasion of the orbit. Arch Otolaryngol 22:154–164, 1935 Gerber PH: Les osteomes du sinus frontal. Arch Int Laryngol Oto Rhinol 23:1–17, 1907 Gibson T, Walker, FM: Large osteoma of the frontal sinus: a method of removal to minimize scarring and prevent deformity. Br J Plast Surg 4:210–217, 1951 Guns P: Osteome du sinus frontal. Acta Otolaryngol 42: 359–364, 1952 Guttich H, Muller ES: Grosses Stirnhohlenosteom und reversible Blindhei. HNO 15:155–158, 1967 Hallberg OE, Begley JW Jr: Origin and treatment of the paranasal sinuses. Laryngoscope 48:29–37, 1938 Halling F, Merten HA, Lepsien G, Honig JF: Clinical and radiological findings in Gardner s syndrome: a case report and followup study. Dentomaxillofac Radiol 21:93–98, 1992 Han MH, Chang KH, Lee CH, Seo JW, Han MC, Kim CW: Sinonasal psammomatoid ossifying fibromas: CT and MR manifestations. AJNR Am J Neuroradiol 12:25–30, 1991 Handousa AS: Nasal osteomata. J. Laryngol Otol 55:197– 224, 1940 Hardwidge C, Varma TR: Intracranial aeroceles as a complication of frontal sinus osteoma. Surg Neurol 24:401– 404, 1985 Hardy JW, Montgomery WW: Osteoplastic frontal sinusotomy: an analysis of 250 operations. Ann Otol Rhinol Laryngol 85:523–532, 1976 Harrison WJ: A case report of osteoma of the orbits resulting in bilateral optic atrophy. Am J Ophthalmol 25:1233– 1236, 1942 Hasso AN: CT of tumors and tumor-like conditions of the paranasal sinuses. Radiol Clin North Am 22:119–130, 1984 Holness RO, Attia E: Osteoma of the frontoethmoidal sinus with secondary brain abscess and intracranial mucocele: case report (letter). Neurosurgery 35:796–797, 1954 Hoover WB, Horrax G: Osteomas of the nasal accessory sinuses with report of a case illustrating the transcranial approach to orbital structures. Surg Gynecol Obstet 61:821– 826, 1935 Jackson WA, Bell KA: Pneumocephalus associated with a frontoethmoidal osteoma. J La State Med Soc 141:33–34, 1989 Jacobson HG: Dense bone—too much bone: radiological considerations and differential diagnosis. Part II. Skel Radiol 13:97–113, 1985 Jain MR, Mogra HS: Gardner’s syndrome presenting as unilateral proptosis. Indian J Ophthalmol 29:55–58, 1981 Jones EL, Cornell WP: Gardner’s syndrome: review of the literature and report on a family. Arch Surg 92:287–300, 1966 Jordan DR, Farmer J, DaSilva V: Psammomatoid ossifying fibroma of the orbit. Can J Ophthalmol 27:194–196, 1992 Karmody CS: Osteoma of the maxillary sinus. Laryngoscope 79:427–434, 1969 Katlan NR, Griffin WR: Osteoma of the orbits. Arch Ophthalmol 65:542–545, 1961

ETHMOID SINUS OSTEOMA, EPIPHORA, AND ORBITAL CELLULITIS 64. 65. 66.

67.

68. 69. 70. 71. 72.

73.

74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84.

85. 86. 87. 88. 89. 90.

Katsantonis GP, Friedman WH, Smith KR Jr: Osteoid-producing orbital ethmoid tumor. Otolaryngol Head Neck Surg 89:717–722, 1981 Kindler W: Stirnhohlenosteom in einer fossilen menschlichen Kalotte aus der Diluvialzeit. Z Laryngol Rhinol Otol 51:399–404, 1972 Knapp H: Subperiosteal enucleatiom of an ivory exostosis of the frontal sinus, extending into the nasal and orbital cavities: healing by first intention. Arch Ophthalmol 9:464– 470, 1880 Kobayasi S, Okmori K, Akizuki T: Combined use of an orbital osteotomy and a living bone graft in the treatment of ossifying tumors of the orbit. J Craniofac Surg 7:156–159, 1996 Kronenberg J, Kessler A, Leventon G: Removal of a frontal sinus osteomoa using the CO2 laser (letter to the Editor). Ear Nose Throat J 65:480–481, 1986 Leiberman A, Tovi F: A small osteoma of the frontal sinus causing headaches. J Laryngol Otol 98:1147–1149, 1984 Liston SL, Barker BF, Cocayne DR: Multiple osteomas of the maxillary sinus. J Oral Surg 37:113–114, 1979 Lowder CY, Berlin AJ, Cox WA, Hahn JF: Benign osteoblastoma of the orbit. Ophthalmology 93:1351–1354, 1986 Lunardi P, Missori P, Di Lorenzo N, Fortuna A: Giant intracranial mucocele secondary to osteoma of the frontal sinuses: report of two cases and review of the literature. Surg Neurol 39:46–48, 1993 Maiuri F, Iaconetta G, Giamundo A, Stella L, Lamaoida E: Fronto-ethmoidal and orbital osteomas with intracranial extension: report of two cases. J Neurosurg Sci 40:65–70, 1996 Margo CE, Weiss A, Habal MB: Psammomatoid ossifying fibroma. Arch Ophthalmol 104:1347–1351, 1986 Marks MW, Newman MH: Transcoronal removal of an atypical orbitoethmoid osteoma. Plast Reconstr Surg 72: 874–877, 1983 Mehta BS, Grewal GS: Osteoma of the paranasal sinuses along with a case report of orbit-ethmoidal osteoma. J Laryngol Otol 77:601–610, 1963 Menezes CAO, Davidson TM: Endoscopic resection of a spheno-ethmoid osteoma: a case report. Ear Nose Throat J 73:598–600, 1994 Mikaelian DO, Lewis WJ, Behringer WH: Primary osteoma of the sphenoid sinus. Laryngoscope 86:728–733, 1976 Miller NR, Gray J, Snip R: Giant, mushroom-shaped osteoma of the orbit originating from the maxillary sinus. Am J Ophthalmol 83:587–591, 1977 Montgomery WW: Osteoma of the frontal sinus. Ann Otol Rhinol Laryngol 69:245–255, 1960 Mortada A: Orbital osteomata within the domain of ophthalmic surgery. Can J Ophthalmol 4:258–265, 1969 Mugliston TA, Stafford N: A cranio-facial approach to large osteomas of the fronto-ethmoidal region. J Laryngol Otol 99:979–983, 1985 Newell FW: Osteoma involving the orbit. Am J Ophthalmol 31:1281–1289, 1948 Noterman J, Patay Z, De Witte O, Salmon I, Brotchi J: Amaurose unilaterale sur osteome du sinus sphenoidal associe a une mucocele: a propos d’un cas. Neurochirurgie 41:419–423, 1995 Novick JN: Osteoma of the frontal sinuses. Arch Otolaryngol 46:655–669, 1947 Noyek AM, Chapnik JS, Kirsh JC: Radionuclide bone scan in frontal sinus osteoma. Aust N Z J Surg 59:127–132, 1989 Olumide AA, Fajemisin AA, Adeloye A: Osteoma of the ethmofrontal sinus: case report. J Neurosurg 42:343–345, 1975 Parsell LA: Osteoma of the frontal sinus. Arch Otolaryngol 16:863–865, 1932 Patterson N, Cairns H: Observations on the treatment of orbital osteoma, with report of case. Br J Ophthalmol 15: 458–467, 1931 Pfeiffer RL: Roentgenography of exophthalmos with notes on roentgen ray in ophthalmology. Am J Ophthalmol 26: 928–942, 1943

91.

92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107.

108.

109. 110.

111. 112. 113. 114. 115. 116. 117.

425

Pompili A, Caroli F, Iandolo B, Mazzitelli MR, Riccio A: Giant osteoma of the sphenoid sinus reached by an extradural transbasal approach: case report. Neurosurgery 17:818– 821, 1985 Pool JL, Potanos JN, Krueger EG: Osteomas and mucoceles of the frontal paranasal sinuses. J Neurosurg 19:130–135, 1962 Rappaport JM, Attia EL: Pneumocephalus in frontal sinus osteoma: a case report. J Otolaryngol 23:430–436, 1994 Rawe SE, VanGilder JC: Surgical removal of orbital osteoma: case report. J Neurosurg 44:233–236, 1976 Rawlings AG: Osteoma of the maxillary sinus: report of a case. Arch Otolaryngol 32:499–505, 1940 Reese AB: Orbital tumors and their surgical treatment: Part 1. Am J Ophthalmol 24:386–394, 1941 Reese AB: Tumors of the Eye. New York, Harper and Row Publishers, 1976, ed 3, p 318 Reese AG: Orbital tumors and their surgical treatment: Part 2. Am J Ophthalmol 24:495–510, 1941 Rizzutti AB: Osteoma of the orbit. Am J Ophthalmol 34:49– 52, 1951 Rothman SL, Kier EL, Allen WE III, Pratt AG: Arteriographic topography of orbital lesions. Am J Roentgenol Radium Ther Nucl Med 122:607–620, 1974 Rowbotham GF: Neoplasms that grow from the bone-forming elements of the skull; a survey of 20 cases. Br J Surg 45: 123–134, 1957 Roy JN: Voluminous orbito-cranial osteoma, consequent cerebral abscess of nasal origin. Am J Ophthalmol 17:515– 519, 1934 Salvolini U, Cavezian R, Pasquet G, Perugini S: L’osteome pedicule du sinus maxillaire: une constatation radiologique rare? J Radiol 65:455–461, 1984 Samy LL, Mostafa H: Osteomata of the nose and paranasal sinuses with a report of twenty one cases. J Laryngol Otol 85:449–469, 1971 Savic DL, Djeric DR: Indications for the surgical treatment of osteomas of the frontal and ethmoid sinuses. Clin Otolaryngol 15:397–404, 1990 Schertel L: Die Holenosteome. Radiologe 15:62–68, 1975 Schieffer U, Petersen D, Hassler W, Wilhelm H, Scheurlen M: Narrowing of the palpebral fissure as the first symptom of extensive osteoma with orbital involvement. Klin Monatsbl Augenheilkd 200:133–137, 1992 Schwartz MS, Crockett DM: Management of a large frontoethmoid osteoma with sinus cranialization and cranial bone graft reconstruction. Int J Pediatr Otorhinolaryngol 20:63–72, 1990 Seiden AM, el Hefny YI: Endoscopic trephination for the removal of frontal sinus osteoma. Otolaryngol Head Neck Surg 112:607–611, 1995 Shady JA, Bland LI, Hazee AM, Pilcher WH: Osteoma of the frontoethmoidal sinus with secondary brain abscess and intracranial mucocele: case report. Neurosurgery 34: 920–923, 1994 Shields JA, Peyster RG, Handler SD, Augsburger JJ, Kaputiak J: Massive juvenile ossifying fibroma of maxillary sinus with orbital involvement. Br J Ophthalmol 69:392–395, 1985 Smith AT: Osseous lesions of nose and sinuses, with special reference to hypertrophic changes and tumor formations. Arch Otolaryngol 31:289–312, 1940 Soboroff BJ, Nykiel F: Surgical treatment of large osteomas of the ethmo-frontal region. Laryngoscope 76:1068–1081, 1966 Som PM, Bellot P, Blitzer A, Som ML, Geller SA: Osteoblastoma of the ethmoid sinus: the fourth reported case. Arch Otolaryngol 105:623–625, 1979 Som PM, Lidov M: The benign fibroosseous lesion: its association with paranasal sinus mucoceles and its MR appearance. J Comput Assist Tomogr 16:871–876, 1992 Spencer MG, Mitchell DB: Growth of a frontal sinus osteoma. J Laryngol Otol 101:726–728, 1987 Sternberg I, Levine MR: Ethmoidal sinus osteoma, a primary cause of nasolacrimal obstruction and dacryocystorhinostomy failure. Ophthalmic Surg 15:295–297, 1984

426 118. 119. 120. 121. 122. 123. 124.

Surv Ophthalmol 43 (5) March–April 1999 Tamari MJ, Weisman EB: Massive osteoma of the ethmoid sinus. Ann Otol Rhinol Laryngol 61:1017–1026, 1952 Taptas JN, Kordiolis N, Liarikos S: Complications orbitaires et endocraniennes des osteomes des sinus paranasaux. Neurochirurgie 25:185–188, 1979 Teed RW: Primary osteoma of the frontal sinus. Arch Otolaryngol 33:255–292, 1941 Thakur V: Osteoma of the lesser wing of the sphenoid. EENT Month 48:619–621, 1969 van Manen SR, Bosch DA, Peeters FL, Troost D: Giant intracranial mucocele. Clin Neurol Neurosurg 97:156–160, 1995 Varboncoeur AP, Vanbelois HJ, Bowen LL: Osteoma of the maxillary sinus. J Oral Maxillofac Surg 48:882–883, 1990 Weber R, Draf W, Constantinidis, J, Keerl R: Current aspects of frontal sinus surgery: IV. On therapy of frontal sinus osteoma. HNO 43:482–486, 1995

MANSOUR ET AL 125. 126. 127. 128.

Whitson WE, Orcutt JC, Walkinshaw MD: Orbital osteoma in Gardner’s syndrome. Am J Ophthalmol 101:236–241, 1986 Wilkes SR, Trautmann JC, DeSanto LW, Campbell RJ: Osteoma: an unusual cause of amaurosis fugax. Mayo Clin Proc 54:258–260, 1979 Zacharia H-S, Asdourian K, Matta CS: Unilateral exophthalmos: aetiological study of 85 cases. Br J Ophthalmol 56: 678–686, 1972 Zonis RD, Montgomery WW, Goodale RL: Frontal sinus disease: 100 cases treated by osteoplastic operation. Laryngoscope 76:1816–1825, 1966

Reprint address: Ahmad M. Mansour, MD, Ophthalmology, American University of Beirut, Blue Bldg, 3rd Floor, Abdul Azeez and Bliss Streets, Beirut, Lebanon.

Lihat lebih banyak...

Comentários

Copyright © 2017 DADOSPDF Inc.