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Frontoethmoidal osteoma with orbital extension. A case report
Osteoma frontoetmoidal con extensión intraorbitaria. A propósito de un caso
I. Blanco Domínguez
, A.V. Oteiza Álvarez, L.M. Martínez González, B. Moreno García-Rubio, G. Franco Iglesias, J. Riba García
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Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "352" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Blanco Domínguez, A.V. Oteiza Álvarez, L.M. Martínez González, B. Moreno García-Rubio, G. Franco Iglesias, J. Riba García" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Blanco Domínguez" "email" => array:1 [ 0 => "ire_blanco@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A.V." "apellidos" => "Oteiza Álvarez" ] 2 => array:2 [ "nombre" => "L.M." "apellidos" => "Martínez González" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Moreno García-Rubio" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Franco Iglesias" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Riba García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteoma frontoetmoidal con extensión intraorbitaria. A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 406 "Ancho" => 925 "Tamanyo" => 71165 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Post-surgical RE hypertrophy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoma is the most common cancer of the paranasal sinuses, with an incidence rate of 0.014–0.43%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> While frontal osteomas represent nearly 80% of all cases,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> sino-orbital location is uncommon.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">They largely affect males aged from twenty to fifty years, and symptoms are commonly headaches, proptosis, facial deformities, diplopia, dizziness and sinusitis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">43-Year old male who has presented right oppressive retroocular pain, headache and nasal congestion, with no fever, for 3 days. He refers several similar episodes in the last few years, and no other history of interest.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Examination revealed visual acuity of a unit (decimal scale) in both eyes. Pupils are isochoric and normoreactive, with absence of relative afferent pupillary defect. There is mild proptosis of the right eye (RE) with peripalpebral inflammation and limitation to supra-duction and dextro-supra-duction of the RE, with binocular diplopia in said positions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The Ishihara test detects a red colour deficiency in the RE and the visual field by confrontation is normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is a mild conjunctival injection in the RE in the anterior pole, with no further abnormalities. Intraocular pressure is 12<span class="elsevierStyleHsp" style=""></span>mmHg in both eyes (BE) and the posterior pole of BE is normal. Cirrus<span class="elsevierStyleSup">®</span> HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA) optic coherence tomography of the papilla shows no data suggesting optic nerve damage.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The blood test is normal and the orbital/facial computed axial tomography (CAT) shows a bone density mass apparently based in the right frontal sinus, with the largest diameter approximately 2<span class="elsevierStyleHsp" style=""></span>cm, which suggests an osteoma and is extended caudally to anterior ethmoid cells and deforms the upper and medial walls of the ipsilateral orbit, limiting the muscular span of the superior oblique muscle, with caudal displacement of the medial and, to a lesser extent and laterally, of the superior rectus muscle (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment is started with amoxicillin/clavulanic acid 875/125<span class="elsevierStyleHsp" style=""></span>mg/1 tab/8<span class="elsevierStyleHsp" style=""></span>h, oral prednisone 80<span class="elsevierStyleHsp" style=""></span>mg daily, omeprazole 20<span class="elsevierStyleHsp" style=""></span>mg/1<span class="elsevierStyleHsp" style=""></span>tab daily, metamizole 1<span class="elsevierStyleHsp" style=""></span>tab/8<span class="elsevierStyleHsp" style=""></span>h and Tobradex<span class="elsevierStyleSup">®</span> eye drops (Alcon-Cusí, Barcelona, Spain) 1 drop/4<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Scheduled with the maxillofacial surgery department, we performed open surgery of the paranasal sinuses, with a bicoronal incision in an anterior subcranial approach, consisting of the removal of several fragments of osteoma, including the one protruding in the orbital cavity and <span class="elsevierStyleItalic">osteum</span>, with cranialisation and obliteration of the frontal sinus by a galeal-pericranial flap, followed by osteosynthesis of the external wall. The pathological results confirmed the diagnosis of osteoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The patient evolves well after the surgery, with improvement of the initial symptoms. His only symptom is hypertrophy of the RE with binocular diplopia in infraversion, grade 5 head-left shoulder torticollis, grade 3 excyclotorsion (Maddox) in the RE and Bielchowsky positive to right shoulder (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), so he was diagnosed with paresis of the IV cranial nerve, treated with 5<span class="elsevierStyleHsp" style=""></span>IU of botulinum toxin in the lower oblique muscle of the RE.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">After one month, the patient was stable with no torticollis or diplopia; the only persistent symptom was asymptomatic mild hyperfunction of the lower oblique muscle of the left eye.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Osteomas are benign bone-forming tumours with slow growth. They are usually asymptomatic, until they spread outside the sinuses and cause complication from mass effect in the brain, the orbit, or locally by obstructing drainage from the sinus in question generating mucoceles.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Despite being a benign condition, they can give rise to serious complications, such as intracranial pneumatocoele, neumoencephalus, meningitis, subdural abscesses or compressive neuropathies.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A conservative attitude is generally preferred to asymptomatic osteomas, controlling growth by series of X-rays. If there is significant growth or intracranial or orbital extension or facial deformities, the attitude should become more aggressive, consisting of surgical removal; the most common procedures are based on an open approach.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The following post-surgical complications have been described: recurring frontal sinusitis, iatrogenic paralysis if the IV cranial pair, post-operative frontal sinusitis with bone resorption in tardive phase and, eventually, loss of the anterior wall of the frontal sinus. Recurrences are extremely rare.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> As a post-surgical complication, our patient presented paresis of the right IV cranial nerve, which resolved after treatment with botulinum toxin; prior to surgery he already presented a limitation of the movements of the upper oblique muscle because of the osteoma.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Sphenoid osteomas are special cases that should be removed as soon as possible due to a high risk of compressive neuropathy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres676669" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec682701" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres676670" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec682700" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-03" "fechaAceptado" => "2016-01-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec682701" "palabras" => array:5 [ 0 => "Osteoma" 1 => "Proptosis" 2 => "Binocular diplopia" 3 => "Subcranial approach" 4 => "Botulinum toxin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec682700" "palabras" => array:5 [ 0 => "Osteoma" 1 => "Proptosis" 2 => "Diplopía binocular" 3 => "Abordaje subcraneal" 4 => "Toxina botulínica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A case is presented of a right frontoethmoidal osteoma with intraorbital invasion in a 43-year-old male, who was seen in the clinic with a proptosis, retro-orbital pain, peri-palpebral inflammation, and binocular diplopia due to muscular route limitation. Open surgery was performed using a subcranial approach, with removal of several fragments of osteoma. Histological analysis confirmed the diagnosis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Osteomas are benign bone-forming tumours with slow growth. They are usually asymptomatic until mass effect complications occur in the brain or in the orbit, or locally, generating mucoceles due to sinus drainage obstruction.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un osteoma frontoetmoidal derecho con invasión intraorbitaria en un varón de 43 años que comenzó como un cuadro de dolor retroocular con proptosis, inflamación peripalpebral y diplopía binocular por limitación del recorrido muscular. Se realizó cirugía abierta mediante abordaje subcraneal anterior, con extirpación de varios fragmentos de osteoma, cuyo análisis histológico confirmó el diagnóstico.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los osteomas son tumores benignos formadores de hueso de crecimiento lento. Habitualmente son asintomáticos, hasta que producen complicaciones por efecto masa en el cerebro o en la órbita, o a nivel local, hasta que obstruyen el drenaje del seno donde asientan, generando mucoceles.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Blanco Domínguez I, Oteiza Álvarez AV, Martínez González LM, Moreno García-Rubio B, Franco Iglesias G, Riba García J. Osteoma frontoetmoidal con extensión intraorbitaria. A propósito de un caso. Arch Soc Esp Oftalmol. 2016;91:349–352.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Paper presented at the 90th Spanish Ophthalmology Society Congress held in Bilbao, from 1 to 4 October 2014.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 272 "Ancho" => 1399 "Tamanyo" => 54474 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Images of the proptosis and inflammation of RE and limitation in supraversion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1384 "Ancho" => 1500 "Tamanyo" => 250494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CT images showing the osteoma. The upper images show the multi-plane reconstruction.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 608 "Ancho" => 1500 "Tamanyo" => 84368 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Post-surgery CT images.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 406 "Ancho" => 925 "Tamanyo" => 71165 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Post-surgical RE hypertrophy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frontal sinus osteoma presenting with orbital emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.S. 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