What kind of tumor is this and where does it grow?
Osteoma consists of mature bone tissue and is a dense formation fused to the wall of the sinus. Based on their structure, there are compact, spongy and mixed variants. Most often, the tumor is found in the frontal sinus, in second place is the ethmoidal labyrinth, less often the maxillary and sphenoid sinuses are affected. Growth is measured in fractions of a millimeter per year, so many osteomas remain the same size for years. The cause of the occurrence has not been precisely established: the role of previous injuries, chronic inflammation and developmental features of the bones of the facial skeleton are being discussed.
- Consists of mature bone tissue
- Most often - frontal sinus
- Grows very slowly over the years
- Compact, sponge and mixed options
- Does not turn into a malignant tumor
Symptoms
As long as the tumor is small and does not block the natural sinus anastomosis, there are no complaints. As it grows, a feeling of pressure and a dull pain in the forehead or bridge of the nose appears, which is not associated with a cold and is difficult to relieve with conventional means. Impaired mucus outflow leads to repeated sinusitis and difficulty in nasal breathing. If the osteoma spreads into the orbit, the eye moves forward or to the side, double vision occurs, and less often vision decreases. When it grows to the anterior cranial fossa, cerebrospinal fluid may leak from the nose and inflammation inside the skull.
- Dull headache in the forehead area
- Feeling of pressure and fullness
- Recurrent sinusitis
- Difficulty in nasal breathing, discharge
- Eyeball displacement and double vision
- Decreased sense of smell
- Rarely - discharge of clear fluid from the nose
Complications due to which the tumor is removed
The main danger is not associated with the tumor itself, but with the fact that it blocks the outflow path from the sinus. Mucus accumulates in a closed cavity, and a mucocele is formed - a stretched cystic formation that gradually destroys thin bone walls and puts pressure on the orbit or cranial cavity. The addition of an infection turns it into a purulent process with the risk of inflammation of the orbit and meninges. Therefore, with osteoma blocking the anastomosis, doctors prefer elective surgery without waiting for complications.
- Sinus block and recurrent sinusitis
- Mucocele with destruction of bone walls
- Inflammation of the fiber of the orbit
- Eye misalignment and visual impairment
- Liquororrhea and intracranial complications
- Cosmetic forehead deformation
Diagnostics
The tumor is often first seen on a regular x-ray of the sinuses as a dense formation with clear boundaries. However, to resolve any issues, a computed tomography scan is needed: it accurately shows the size, location of attachment, relationship to the wall of the orbit and base of the skull, as well as the condition of the anastomosis. Endoscopic examination of the nasal cavity allows us to assess the patency of the outflow tract and the condition of the mucous membrane. MRI is added if a mucocele or extension beyond the sinus is suspected. If there are multiple osteomas and intestinal polyps in the family, Gardner syndrome is excluded.
- MSCT of the paranasal sinuses is the main method
- X-ray of the sinuses as a primary study
- Endoscopy of the nasal cavity
- MRI for suspected mucocele and complications
- Examination by an ophthalmologist for eye symptoms
- Examination of the intestine for multiple osteomas
Treatment and observation
A small asymptomatic osteoma is not removed: a control tomography at intervals determined by the doctor is enough to make sure that it is not growing. Indications for surgery include headache, recurrent sinusitis, anastomosis block, extension into the orbit or base of the skull, cosmetic deformity, and noticeable growth on follow-up. Most osteomas today are removed endoscopically through the nose, without external incisions; For large formations of the frontal sinus, a combined approach is used. At the same time, the outflow from the sinus is restored. After the operation, they are observed by an ENT doctor; repeated formations are rare.
- Observation with control CT scan for small asymptomatic osteomas
- Endoscopic removal through the nasal cavity
- Combined approach for large frontal osteomas
- Restoration of outflow from the sinus
- Treatment of concomitant sinusitis
- Follow-up examinations by an otolaryngologist after surgery
