Figure 5. Drainage tube through the frontal recess The histopathologic examination confirmed the diagnosis of left frontal sinus osteoma.
[Nasal sinus papillomas].
The postoperative evolution was favorable. The patient received i. Daily dressing change was performed, as well as aspiration through and around the drainage tube.
Managementul papilomului inversat din sinusurile paranazale. Source: ORL. Author s : Manea, Claudiu Abstract: Inverted papilloma is a common epithelial benign tumour, of uncertain aetiology, arising from the outlining Schneiderian respiratory membrane. This locally aggressive neoplasm is a lesion of the mucosal membrane of the nasal cavity and the paranasal sinuses, composed of welldifferentiated columnar or ciliated respiratory epithelium. It has a high risk of association with malignancies.
The postoperative ENT reevaluation was performed after 14 days Figure 6at one month, at three months, and at six months. Figure 6. ENT reevaluation at 14 days after surgery Discussion Osteoma is the most common tumor of paranasal sinuses, often with a slow and silent evolution.
The most frequently involved site is frontal sinus, followed by ethmoid and maxilar sinuses. The sphenoid sinus is rarely involved 1,2. In general, the dimension of osteomas may vary between 2 and 30 mm.
The procedure implies surgical excision of the lateral nasal wall and ethmoid sinus. This technique is aided by the usage of adequate instruments, such as 0° and 70° scopes and angulated surgical instruments, which allow the complete visualization and access to the maxillary sinus.
Osteomas bigger than 30 mm or the ones weighing more than g are considered to be giant 4. The etiology of osteomas is still unknown.
Several hypotheses have been taken into consideration: traumatic or infectious triggers, calcium metabolism disorders, or embryonic malformations 5.
Frontal sinus osteoma grading system 6 Grade I.
The base of attachment is posterior-inferior along the frontal recess. The tumor is medial to a virtual sagittal plane through the lamina papyracea.
Grade II. Grade III. Grade IV.
Tumor fills the entire frontal sinus the current case. Osteomas are white, hard, well circumscribed, round or oval, sesile rarely pediculatedbosselated tumors. Histologically, osteoma is composed of lamellar, mature bone with haversian-like systems, surrounded by fibrous, paucicellular stroma 7.
The diagnosis of osteoma is established by clinical and paraclinical exams.
Endoscopic medial maxillectomy for inverted papilloma
The patients may complain of persistent frontal pain unresponsive to analgesic or antiinflammatory medication, hemifacial pain, rhinoreea and nasal obstruction. Computed tomography of the head and paranasal sinuses is the gold standard for the diagnosis of osteoma and is also necessary for its management. MRI is useful when intracranial extensions are suspected 8. The management of the frontal sinus osteoma depends on the severity of the symptoms and the extension of the tumor.
If chronic sinusitis unresponsive to treatmentpersistent headaches when all other causes have been excluded or mucocele occur, the therapeutic approach is surgical. It can be external, endoscopic or combined: external inverted papilloma of nose and paranasal sinuses the removal of the tumor, and endoscopic to provide the appropriate drainage from the frontal sinus.
Inverted papilloma of nose and paranasal sinuses approach depends oxiuri ficat on the site and dimension of the osteoma. Sometimes, there are cases of small frontal recess osteomas which can be approached only by endoscopic approach.
The definitive diagnosis of osteomas can be established only after the histological examination of the tumor.
Frontal sinus osteoma – case report
If osteoma is big, extending through the sinus wall to the intracranial space, a multidisciplinary surgical approach will be mandatory: otorhinolaryngologist and neurosurgeon.
The postoperative complications which may occur are: subcutaneous emphysema, persistent suppurative sinusitis, fistulization, inverted papilloma of nose and paranasal sinuses osteomyelitis, supraorbitar nerve branches damage, supraorbitar neuralgia, ecchymosis, palpebral edema, dyplopia, epiphora, frontal recess stenosis, recurrence of frontal sinusitis, and tumoral recurrence.
The current case had a classic, slow onset and progression, affecting a middle aged female patient. The symtoms have occured gradually: progressive headache started 12 months before the admission to the hospital.
Recurrent Inverted Papilloma
The presumptive diagnosis was established after clinical inverted papilloma of nose and paranasal sinuses paraclinical examinations transnasal endoscopy, native computed tomography of the head and paranasal sinuses.
The definitive diagnosis was established by the histological examination of the tumor.
- Cancer de colo de utero pelo hpv
- Reteta detoxifiere ghimbir
- Virus papiloma en nariz
Разве нет обходного пути.