Giant ethmoid osteoma with orbital extension, a nasoendoscopic approach using an intranasal drill

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.