Hm. Huang et al., Giant ethmoid osteoma with orbital extension, a nasoendoscopic approach using an intranasal drill, LARYNGOSCOP, 111(3), 2001, pp. 430-432
Objective: Ethmoid osteoma is a slow-growing, benign, and encapsulated bony
tumor. Symptoms occur earlier than with osteomas of the frontal sinus beca
use of the small volume of the ethmoid sinus. Interestingly, orbital extens
ion is uncommon. Treatment remains controversial, with open procedures typi
cally being used, In this article, we present a less invasive yet safe and
effective approach to treatment. Study Design: A nasoendoscopic approach us
ing a Stammberger-Saches intranasal drill was developed for treatment of pa
tients with ethmoid osteoma, with or without orbital extension. Between 199
5 to 1999, seven patients underwent the new surgical procedure. Methods: Al
l procedures were performed under general anesthesia. Using 0 degrees and 3
0 degrees endoscopes, surface anesthesia of the nasal mucosa was performed,
the anterior ethmoid cell was resected, and the whitish osteoma found. The
osteoma was drilled out inferolaterally to superomedially, In the patient
with orbital extension, a double-ended blunt elevator was used to separate
the remaining osteoma from the lamina papyracea and to push the residual os
teoma medially toward the nasal septum, With alternate drilling and elevati
on, the osteoma was gently removed. The surgical site was then packed. Resu
lts: The method successfully treated all patients. There were no major comp
lications. The single patient with orbital extension had mild postoperative
periorbital ecchymoses, Nasoendoscopy showed normal epithelialization 4 to
6 weeks after surgery. Computed tomography showed no residual tumors 6 mon
ths after surgery. Conclusion: The 30 degrees nasoendoscopic approach using
an intranasal drip provides a good operative field and is a safe and effec
tive technique, with the potential to become the treatment of choice in sel
ected cases.