Frontoethmoidal and intraorbital osteomas: exploring the limits of the endoscopic approach.
OBJECTIVE
To review our experience with the surgical treatment of frontoethmoidal osteomas, focusing on the osteomas that were either localized laterally in the frontal sinus or showing intraorbital involvement.


METHODS
Retrospective evaluation.


METHODS
Tertiary care center.


METHODS
Patients with symptomatic frontoethmoidal or intraorbital osteomas who had been treated surgically from 1996 through 2011.


METHODS
Sixty frontoethmoidal osteomas were treated surgically. The lesion involved the far lateral portion of the frontal sinus in 23 cases and the orbital region in 6 cases. In 31 cases, a purely endoscopic approach was performed while a combined procedure was used in 25 patients. In 4 patients, an exclusively external approach was required.


METHODS
No recurrence of osteoma.


RESULTS
Radical resection was obtained, except in the case of 2 lesions. No osteoma recurrence was observed during a mean follow-up of 72.6 months.


CONCLUSIONS
The size of the osteoma, far lateral extension of the tumor in the frontal sinus beyond the lamina papyracea, and intraorbital involvement are no longer absolute contraindications for purely transnasal endoscopic resection. What is important is that the surgeon should not be dogmatic but rather be ready to change his or her mind during surgery, shifting to an external approach when required.
Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy. tzmario@inwind.it
Mario
M
Turri-Zanoni
Iacopo
I
Dallan
Paola
P
Terranova
Paolo
P
Battaglia
Apostolos
A
Karligkiotis
Maurizio
M
Bignami
Paolo
P
Castelnuovo
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005005:Ethmoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010016:Osteoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome