Transnasal endoscopic approach to symptomatic sinonasal osteomas.
BACKGROUND
One of the most challenging benign tumors for the ear, nose, and throat (ENT) surgeon is represented by sinonasal osteomas. Surgical treatment should regard just symptomatic osteomas, because these tumors can provoke rhinosinusitis and mucoceles. Recently, new  instruments have been applied in endoscopic sinus surgery (ESS). This study was designed to present our experience in the endoscopic management of osteomas of the paranasal sinuses. Clinical findings, preoperative imaging strategy, and surgical techniques are discussed.


METHODS
We retrospectively reviewed clinical records of patients who underwent ESS for sinonasal osteomas between 2003 and 2010 in our institutions.


RESULTS
We have treated with a transnasal endoscopic approach 29 patients affected by paranasal osteomas (13 men and 16 women;  age range, 20-78 years; mean, 49.5 years). We found frontoethmoidal junction localization in 14 patients, frontal sinus in 6 patients, ethmoid in 6 patients, sphenoid in 1 patient, maxillary in 1 patient, and multiple osteomas in 1 patient. Initially, patients were treated by the cavitation  technique with standard ESS instruments, whereas in more recent cases surgery was assisted by the use of ENT navigation system, curved drills, and ultrasound bone emulsifier. No major complications occurred. No radiological or endoscopic signs of recurrence (mean follow-up, 52 months; range,  6-89 months) have been observed.


CONCLUSIONS
Endoscopic removal of osteomas of the sinonasal region is feasible, taking into account the location and size of the lesion. Particular importance should be given to new instruments that have been applied in the last years  in ESS.
Department of Otorhinolaryngology, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia, Italy. tpagella@libero.it
Fabio
F
Pagella
Alessandro
A
Pusateri
Elina
E
Matti
Enzo
E
Emanuelli
D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010016:Osteoma / Q000000981:diagnostic imaging / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed