Endonasal Endoscopic Resection of Giant Ethmoido-Orbital Osteoma with Intra Orbital Extension

Objective: Osteoma is a benign, osteogenic tumor that usually grows slowly and asymptomatically. Giant ethmoidoorbital osteoma is a rare event that can give rise to ocular signs and symptoms; in such a case treatment is mandatory, although debates persist regarding the optimal approach. Methods: Between 1999 and 2007, six patients (four men and two women) with giant ethmoido-orbital osteomas were treated using endonasal endoscopic approach. Their ages ranged from 17 to 63 years (mean 46.3 yr). All procedures were performed under general anaesthesia using 0 ° and 30° nasal endoscopes. The osteoma was fragmented using intranasal drill and then the divided parts were detached from surrounding structures and pulled out of the nose. Finally the surgical site was packed. Results: The transnasal endoscopic approach was successful in all six patients. Follow up period ranged from 12 months-8 years (mean 46 months). There were no major complications and only one patient had postoperative persistent epiphora which was treated by endoscopic DCR and insertion of silicon tube. Conclusion: In selected cases of ethmoido-orbital osteomas, endonasal endoscopic approach provides a safe and effective alternative to open approaches, offering cosmetic advantages and lowering the morbidity.