Giant orbitoethmoidal osteoma in children is considered to be rare. This type of pathology can be associated with significant disfiguring proptosis and limitation of eye movement. Here, we report on a child who presented with a giant orbitoethmoidal osteoma that was removed through an orbitofrontal approach. The cosmetic result was excellent and evident immediately after surgery. A review of the literature complements this report.
Osteomas are uncommon tumors that constitute 1% of all bone tumors and 11% of benign bone tumors [
A 16-year-old boy presented with progressive proptosis in the left eye that had first appeared 3 years earlier. He had recently developed limitation of left-eye movement associated with double vision. During physical examination, downward deviation and protrusion of the left eye and limitations of lateral and vertical gaze were evident (Figure
Patient photo demonstrating the degree of proptosis and limitation of eyemovements (a). Computerized tomography (axial (b) and coronal (c)) depicting giant osteoma feature at the orbitoethemoidal region and the degree of orbital compression.
The features of this mass are suggestive of osteoma. The mass was removed through a left fronto-orbital approach. A supraorbital frontal craniotomy was carried out, exposing the osteoma at the supraorbital and the ethmoid regions (Figure
Intraoperative photo showing the large osteoma exposed through a fronto-orbital surgical approach.
Postoperative patient photo demonstrating the resolution of proptosis and fulleye movements (a). Preoperative coronal MRI orbit showing the degree of compression on the orbit (b). Postoperative CT orbit showing the resolution of proptosis (c).
Osteomas are exceedingly rare benign osteogenic tumors [
The etiology of osteomas remains elusive. Three different hypotheses have been described in the literature, identifying possible instigators for osteoma formation [
Most osteoma patients are asymptomatic. It is estimated that around 1% of osteomas are discovered incidentally on sinus plain X-rays, while only 3% are detected via CT scans [
Surgical techniques for the treatment of osteomas remain controversial. The surgical approach should be based on tumor size, tumor location, and the surgeon’s preference and experience [
With recent technological innovation in the surgical techniques and the introduction of endoscopic surgical interventions, many authors consider endoscopic resection of ethmoidal and orbitoethmoidal osteomas to be the new modality of choice for resecting such lesions [
The surgical goal is to achieve complete surgical resection, protect vital structures (cribriform plate, optic nerves, lacrimal apparatus, anterior and posterior ethmoidal arteries, and the trochlea), and achieve favorable aesthetic outcomes [
Most literatures describing giant orbitoethmoidal osteomas are case reports and small series. Therefore, the superiority of one surgical approach over the other is not yet established. However, in the presence of gigantic lesions with lateral extension beyond the orbital midline, as seen in our case, open surgical approaches are effective and were deemed more desirable.
Giant orbitoethmoidal osteomas have been managed with open approaches for decades. Only scarce case reports and small series are present in the literature. Our case adds to the growing literature on giant orbitoethmoidal osteomas managed successfully using open surgical approaches. Although the endoscopic endonasal approach demonstrates a safe and effective technique for the surgical management of giant orbitoethmoidal osteomas, the presence of a giant orbitoethmoidal osteoma that extends superolaterally into the orbital and frontal regions beyond the orbital midline might limit the endoscopic approach, and an open procedure offers the optimal surgical approach and orbitofrontal reconstruction.
Permission consent was taken from the patient guardian and patient to display his photo in this paper.
The authors declare that they have no conflict of interests.