DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20184345

Fibro-osseous lesions of the paranasal sinuses and the skull base

Sajedh M. Alturaiki, Ali Almomen, Ghaleb Al Azzeh, Abdulrahman Al Khatib, Nada Alshaikh

Abstract


Background: Osteomas, ossifying fibromas, and fibrous dysplasia comprise a set of benign neoplasms known as fibro-osseous lesions (FO), which can arise in the paranasal sinuses. The vast majority of benign FO lesions (BFOL) are incidental findings on radiographs. They tend to be slow-growing tumors, and are infrequently symptomatic. The management strategy can vary significantly for theses lesions. This can range from serial, observations to aggressive surgical resection, based on symptomatology, size, and location of the lesion.

Methods: Retrospective analysis of all the data of different symptomatic FO of the paranasal sinuses and the skull base was performed at King Fahad specialist hospital, Dammam, KSA (2006 to 2017).  

Results: A total of 21 patients were identified; 10 (46.7%) patients were diagnosed with osteoma, 8 (38.1%) with fibrous dysplasia, 2 (9.5%) with ossifying fibroma and one (4.8%) with juvenile active ossifying (JAOF), 17 were adults and 4 were children, the range of f/u (3-60) months. 19 patients were managed by the endonasal endoscopic approach. They continue to be followed with no evidence of recurrence. Two cases required the revision combined endoscopic open approach to ensure adequate removal of the disease (residual and recurrence).

Conclusions: Diagnostic dilemma of BFOL can be overcome with a combination of clinical, radiological and pathological criteria. Correct diagnosis of fibro-osseous tumors is crucial for adequate therapy as their treatment, prognosis, clinical aggressiveness and long term complications of individual entities vary significantly. Endoscopic computer-assisted surgery is the treatment of choice. Endoscopic resection remains a technical challenge. 


Keywords


Fibro-osseous lesion, Osteoma, Fibrous dysplasia, Ossifying fibrom

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References


Brodish BN, Morgan CE, Sillers MJ. Endoscopic resection of fibro-osseous lesions of the paranasal sinuses. Am J Rhinol. 1999;13:11-6.

Busch RF. Frontal sinus osteoma: Complete removal via endoscopic sinus surgery and frontal sinus trephination. Am J Rhino & Allergy 1992;l4:139-43.

Seiden AM, EL HefnyYI. Endoscopic trephination for the removal of frontal sinus osteoma. Otolaryngol Head Neck Surg. 1995;112:607-6.

Ooi EH, Glicksman JT, Vescan AD, Witterick IJ. An alternative management approach to paranasal sinusfibro-osseous lesions. Int Forum Allergy Rhinol. 2011;1(1):55-63.

Efune G, Perez CL, Tong L, Rihani J, Batra PS. Paranasal sinus and skull base fibro-osseous lesions: when is biopsy indicated for diagnosis? Int Forum Allergy Rhinol. 2012;2(2):160-5.

Eller R, Sillers M. Common Fibro-osseous Lesions of the Paranasal Sinuses. Otolaryngolclin North Am. 2006;39:585-600.

Schick B, Steigerwald C, el Rahman el Tahan A, Draf W. The role of endonasal surgery in the management of frontoethmoidal osteomas. Rhinology. 2001;39(2):66–70.

Mahabir RC, Szymczak A, Sutherland GR. Intracerebral pneumatocele presenting after air travel. J Neurosurg. 2004;101(2):340–2.

Nabeshima K, Marutsuka K, Shimao Y, Uehara H, Kodama T. Osteoma of the frontal sinus complicated by intracranial mucocele. Pathol Int. 2003;53(4):227–30.

Roca B, Casado O, Borras JM, Gonzalez-Darder JM. Frontal brain abscess due to Streptococcus pneumoniae associated with an osteoma. Int J Infect Dis. 2004;8(3):193.

Naraghi M, Kashfi A. Endonasal endoscopic resection of ethmoido-orbital osteoma compressing the optic nerve. Am J Otolaryngol. 2003;24(6):408–12.

Osma U, Yaldiz M, Tekin M, Topcu I.. Giant ethmoid osteoma with orbital extension presenting with epiphora. Rhinology 2003;41(2):122–4.

Gezici AR, Okay O, Ergün R, Dağlioğlu E, Ergüngör F. Rare intracranial manifestations of frontal osteomas. Acta Neurochir (Wien). 2004;146(4):393–6

Akay KM, Ongürü O, Sirin S, Celasun B, Gönül E, Timurkaynak E. Association of paranasal sinus osteoma and intracranial mucocele–two case reports. Neurol Med Chir (Tokyo). 2004;44(4):201-4.

Summers LE, Mascott CR, Tompkins JR, Richardson DE. Frontal sinus osteoma associated withcerebral abscess formation: a case report. Surg Neurol. 2001;55(4):235–9.

Eller R, Sillers M. Common fibro-osseous lesions of the paranasal sinuses. Otolaryngol Clin North Am. 2006;39:585–600.

Park W, Kim HS. Osteoma of maxillary sinus: case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(6):26-7.

Chen C, Selva D, Wormald PJ. Endoscopic modified Lothrop procedure: an alternative for frontal osteoma excision. Rhinology. 2004;42(4):239–43.

Sayan NB, Uçok C, Karasu HA, Günhan O. Peripheral osteoma of the oral and maxillofacial region: a study of 35 new cases. J Oral Maxillofac Surg. 2002;60(11):1299–301.

Schreibera A, Villareta AB, Maroldib R, Nicolaia P. Fibrous dysplasia of the sinonasal tract and adjacent skull base, curropinotolaryngol head neck surg. 2012;20:45-52.

Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A, et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl. 2010;1:1–143.

Sadeghi SM, Hosseini SN. Spontaneous conversion of fibrous dysplasia intoosteosarcoma. J Cranio Fac Surg. 2011;22:959–61.

Sadeghi SM, Hosseini SN. Spontaneous Conversion of Fibrous Dysplasia Into Osteosarcoma, J Craniofac Surg. 2011;22:959-61.

Moore RT, Buncic JR, Munro IR. Fibrous dysplasia of the orbit in childhood: clinical features and management. Ophthalmology. 1985;92(1):12-20.

DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg Am. 2005;87:1848-64.

Ohmori K, Matsui H, Kanamori M, Yudoh K, Yasuda T, Terahata S.. Malignant fibrous histiocytoma secondary to fibrous dysplasia. A case report. Int Orthop. 1996;20:385-8.

Ricalde P, Horswell BB. Craniofacial fibrous dysplasia of the fronto-orbital region: a case series and literature review. J Oral Maxillofac Surg. 2001;59:157-68.

Kaushik S, Smoker WRK, Frable WJ. Malignant transformation of fibrous dysplasia into chondroblastic osteosarcoma. Skeletal Radiol. 2002;31:103-6.

Maroldi R, Berlucchi M, Farina D, Tomenzoli D, Borghesi A, Pianta RL. Benign Neoplasms and Tumor-Like Lesions. Imaging in Treatment Planning for Sinonasal Dis. 2005: 107-58

Hamner JE, Scofeild HH, Cornyn J. Benign fi bro-osseousjaw lesions of periodontal membrane origin. Cancer. 1968;22:861–78.

Harrison D, Lund VJ. Tumours of the Upper Jaw. London: Churchill Livingstone; 1993.

Shanmugaratnam K. Histological typing of tumours of the upper respiratory tract and ear. New York: Springer-Verlag, Berlin Heidelberg; 1991.

Johnson LC, Yousefi M, Vinh TN, Heffner DK, Hyams VJ, Hartman KS. Juvenile active ossifying fi broma: its nature, dynamics and origin. Otolaryngol Stockh (Suppl). 1991;488:1–40.

Eversole R, Su L, ElMofty S. Benign Fibro-osseous lesions of the craniofacial complex. Head Neck Pathol. 2008;2(3):177-202.

Marvel JB, Marsh MA, Catlin FI. Ossifying fi broma of the mid-face and paranasal sinuses: diagnostic and therapeutic considerations. Otolaryngol Head Neck Surg. 1991;104:803–8.

London SD, Schlosser RJ, Gross CW. Endoscopic management of benign sinonasal tumors: a decade of experience. Am J Rhinol. 2002;16:221–7.

Redaelli de Zinis LO, Ansarin M, Galli G. Approcciochirurgicotrans basale-subfrontale in un caso di fi bromaossificanteetmoidale. Gior Pat Chir Cr Fa. 1996;2:42–5.