title: Endoscopic Resection of Giant Ethmoid Osteomas with the Assistance of an Image-guidance System.
abstract: OBJECTIVE
  To investigate the minimally invasive ablation of giant osteoma of the ethmoid sinuses endonasally with the assistance of an image-guidance system.
  
  
  METHODS
  A retrospective analysis was carried out on 12 patients with osteomas of ethmoid sinuses treated by endoscopic surgery with the help of a navigation system from April 2005 to October 2013.
  
  
  RESULTS
  Osteomas in all 12 patients were giant and connected extensively with the anterior skull base, lamina papyracea, or orbital apex, and were removed successfully with the help of an endoscope and image navigation system under general anaesthesia. In two cases (one through superciliary arch incision and the other one through labiogingival incision), the procedure was combined with an external procedure to remove osteomas. All patients were followed-up for 8 to 64 months. No recurrences were found. All symptoms gradually vanished or reduced dramatically after surgery. One case of frontal mucocele was observed and was successfully removed 5 years after removal of the osteoma. Anosmia occurred in both patients who underwent crista galli resection, and no recovery was noted 9 and 26 months later. Cerebrospinal fluid rhinorrhea was found in one case during surgery and was repaired with mucosa of inferior nasal concha immediately, and primary healing was successful.
  
  
  CONCLUSIONS
  Endoscopic ablation of giant osteomas of the ethmoid sinuses with the guidance of a navigation system is an accurate, secure, minimally invasive procedure. A careful study of the preoperative computed tomographic scan is necessary for the success of the operation. If the lesion extensively affects the frontal sinus and maxillary sinus, a combination of superciliary arch incision and labiogingval groove incision is a simple, easy and elegant option.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China Department of Imaging of Head and Neck, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
authors.forename: Yunqiang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
authors.forename: Dajian
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China Department of Anaesthesia of Head and Neck, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
authors.forename: Aihua
authors.initials: A
authors.lastname: Jiang
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China.
authors.forename: Zhonglu
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, P.R. China songxicheng@126.com.
authors.forename: Xicheng
authors.initials: X
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods; D005005:Ethmoid Sinus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010016:Osteoma / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: Osteoma; endoscope; ethmoid sinuses; navigation; surgery