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American Journal of Rhinology & Allergy Nov 2018Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may...
BACKGROUND
Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may lead to intracranial complications or orbital and optic nerve compression.
OBJECTIVE
To assess the presentation and management of benign paranasal sinus osteoneogenic tumors.
METHODS
Systematic review of the symptoms and surgical treatment of these lesions, and a case series of 2 adolescents with osteomas impinging on the orbit treated with a multiportal approach.
RESULTS
Forty-eight cases of osteomas, osteoblastoma, or osteoid osteomas were reviewed from 43 articles. The average age was 14 years, 67% of tumors were osteomas, and 48% were greater than 3 cm in longest dimension. Compared to osteoblastomas, osteomas had a greater male to female ratio (4.3:1; P = .02), presented at older age ( P = .03) with a smaller tumor burden ( P = .003), and had prior trauma or surgery ( P < .001). The ethmoid, frontal, maxillary, and sphenoid sinuses were affected in decreasing order of frequency. A purely endoscopic sinus surgery approach was taken in 31% of cases, open approach in 62% of cases, and combined approach in 7% of cases. Osteoblastoma patients had a 32% rate of recurrence, compared to only 3% among osteoma patients. On univariate logistics regression of patient demographics, tumor characteristics, and surgical approaches predictive of surgical outcomes, only tumor type was predictive of postoperative recurrence (odds ratio: 0.07; 95% confidence interval, 0.007-0.77; P = .029).
CONCLUSION
There was no association between surgical approach and postoperative complications or rate of recurrence. However, a transnasal and transorbital multiportal approach avoids facial incisions.
Topics: Adolescent; Bone Neoplasms; Carcinogenesis; Child; Endoscopy; Headache; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Orbit; Osteogenesis; Osteoma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed
PubMed: 30132339
DOI: 10.1177/1945892418793475 -
Journal of Orthopaedic Case Reports 2020Patellar involvement by osteoid osteoma is very rare. Osteoid osteomas that present as anterior knee pain are frequently misdiagnosed which leads to initial delay in...
INTRODUCTION
Patellar involvement by osteoid osteoma is very rare. Osteoid osteomas that present as anterior knee pain are frequently misdiagnosed which leads to initial delay in treatment. Plain radiology has poor diagnostic yield. A combination of high index of suspicion, appropriate imaging, and complete ablation of the lesion is necessary to achieve good outcomes.
CASE REPORT
A 16-year-old male presented with insidious onset anterior knee pain for the past 2 years. The pain was intermittent and mild; however, it increased progressively in intensity and frequency, which was worse at night. Examination reveals minimal effusion in the suprapatellar pouch, full range of motion of the knee, and wasting of the quadriceps. Serum biochemistry parameters were in normal limits. Plain radiographs did not reveal any significant abnormality. On magnetic resonance imaging, a hypointense, punctate lesion surrounded by a small hyperintense zone was noted at medial aspect of patella. A computed tomography scan showed the lesion with a central nidus, surrounded by a sclerotic rim, confirming the diagnosis of osteoid osteoma. Radiofrequency ablation was carried out without any post-procedural complications. The patient was pain free a few days after the procedure. At 14-month follow-up, there was no recurrence of symptoms.
CONCLUSION
Osteoid osteomas that present as anterior knee pain are frequently misdiagnosed. Plain radiology has poor diagnostic yield. A combination of high index of suspicion, appropriate imaging, and complete ablation of the lesion is necessary to achieve good outcomes.
PubMed: 32953651
DOI: 10.13107/jocr.2020.v10.i02.1684 -
The Journal of Craniofacial Surgery 2020To describe the osteoplastic approach and to perform a systematic review of the indications and outcomes of the osteoplastic flap procedure for frontal sinus surgeries...
OBJECTIVE
To describe the osteoplastic approach and to perform a systematic review of the indications and outcomes of the osteoplastic flap procedure for frontal sinus surgeries with or without obliteration.
DATA SOURCES
PubMed, Medline, Google Scholar, and Cochrane databases.
REVIEW METHODS
All published studies in the English language on the osteoplastic flap with or without obliteration were identified from 1905 to 2018. All studies with <20 patients were excluded. The number of patients, technique, indications, follow-up period, symptom relief, revision rates, and complications were recorded and analyzed.
RESULTS
A systematic review yielded 25 series containing 1374 patients for analysis. Indications for surgery included chronic frontal sinusitis, mucoceles, fractures or traumas, osteomas, neoplasms, and cerebrospinal fluid leak. The mean follow-up period ranged from 12.8 to 144 months. The percentage of patients needing revisions for frontal sinus disease was 6.2%. There was a high rate of symptomatic improvement (85.0%) and a low rate of major complications (0.7%). However, minor complications occurred in 19.4% of patients.
CONCLUSION
The osteoplastic flap with or without obliteration has many indications. In an era where endoscopic technique provides excellent access to the frontal sinuses, external approaches remain a useful adjunct, and/or salvage technique. In experienced hands, the osteoplastic flap can yield excellent long-term clinical results, with low rates of complications. Regardless of the surgical approach, long-term follow-up is necessary due to the recurrent nature of frontal sinus disease.
Topics: Humans; Paranasal Sinus Diseases; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome
PubMed: 33136864
DOI: 10.1097/SCS.0000000000006717 -
European Archives of... Jan 2024To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence.
DATA SOURCES
A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via "PubMed", "Embase", and "Google scholar" search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling.
RESULTS
The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01-0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00-0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02-0.15).
CONCLUSION
EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.
Topics: Humans; Ear Canal; Retrospective Studies; Ear Neoplasms; Hearing Loss; Osteoma
PubMed: 37335347
DOI: 10.1007/s00405-023-08074-x -
European Radiology Nov 2020CT-guided radiofrequency ablation (CT-RFA) is considered to be the gold standard for treatment of osteoid osteoma (OO) yet treatment failures (TFs) continue to be...
OBJECTIVES
CT-guided radiofrequency ablation (CT-RFA) is considered to be the gold standard for treatment of osteoid osteoma (OO) yet treatment failures (TFs) continue to be reported. This systematic review was conducted to evaluate factors associated with TF, such as ablation time, lesion location, and patient age as well as evaluating how TF has trended over time.
METHODS
Original studies reporting on patients undergoing CT-RFA of OO published between 2002 and 2019 were identified. TF was defined as patients with (1) recurrent or persistent pain +/- (2) imaging evidence of persistent OO. TFs were subdivided into those occurring after the index procedure (primary TF) or those occurring after repeat RFA (secondary TF). Subgroup analysis was performed for TF based on the study date (2002-2010 or 2010-2019), time duration of ablation at 90 °C (6 min or > 6 min), patient age, and tumor location (spinal vs. appendicular).
RESULTS
Sixty-nine studies were included for a total of 3023 patients. The global primary TF rate was 8.3% whereas the secondary TF rate was 3.1%. The TF rate reported in studies published after 2011(7%) was about half that during the earlier time period 2002-2010 (14%). There was no statistical difference in TF corrected for age, OO location, or duration of ablation (respectively p = 0.39, 0.13, and 0.23). The global complication rate was 3%, the most frequent being skin burns (n = 24; 0.7%).
CONCLUSIONS
A decrease in TF observed between 2011-2019 compared to 2002-2010 may reflect improvements in operator technique or advancements in equipment. Duration of ablation, patient age, or location of OO failed to significantly correlate with TF.
KEY POINTS
• CT-guided radiofrequency ablation of osteoid osteomas is a safe technique with a low rate of treatment failure (8.3% failure rate after the primary radiofrequency reducing to 3.1% following a secondary treatment). • The treatment failure rate has decreased over time, possibly due to an improved understanding of the disease process, better technique, and advances in equipment. • Duration of ablation, patient age, or lesion location did not significantly correlate with treatment failure.
Topics: Bone Neoplasms; Catheter Ablation; Humans; Osteoma, Osteoid; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32518986
DOI: 10.1007/s00330-020-06970-y -
European Archives of... Aug 2020The olfactory groove (OG) is a common site of iatrogenic cerebrospinal fluid (CSF) leak during endoscopic sinus surgery. We aimed to evaluate the prevalence of CSF leak...
PURPOSE
The olfactory groove (OG) is a common site of iatrogenic cerebrospinal fluid (CSF) leak during endoscopic sinus surgery. We aimed to evaluate the prevalence of CSF leak during endoscopic removal of osteomas involving the OG and identify CT findings indicating increased risk of this complication.
METHODS
A retrospective review was conducted of patients operated on for frontoethmoidal osteoma from 11 years in a single institution. A retrospective review of the literature, 1999 to 2019, of perioperative complications in patients operated on for frontoethmoidal osteoma using endoscopic or combined approaches.
RESULTS
Case series: 73 patients were identified including 17 with the OG involvement. The only case of CSF leak occurred in a patient with spongious part of osteoma at the OG. Among six osteomas with spongious component at the OG, one was detached and five had to be drilled down, leaving a small remnant in four. In contrast, all the 11 osteomas with ivory part at the OG were safely detached and completely removed from the OG after debulking. The prevalence of CSF leak was not statistically different between the patients without and with involvement of the OG. Systematic review of the literature: Among the 273 identified patients there were 8 cases of intraoperative CSF leaks (3%) including 2 from the OG (0.7%).
CONCLUSION
Involvement of the OG does not significantly increase the risk of intraoperative CSF leak. However, this risk may be increased in patients with the spongious part of the tumor attached to the OG.
Topics: Cerebrospinal Fluid Leak; Cranial Fossa, Anterior; Endoscopy; Humans; Osteoma; Retrospective Studies; Skull Base
PubMed: 32253533
DOI: 10.1007/s00405-020-05938-4 -
American Journal of Otolaryngology 2021Surgical excision represents the unequivocal treatment modality for symptomatic paranasal sinus osteomas. However, the optimal surgical approach and the extent of the...
BACKGROUND
Surgical excision represents the unequivocal treatment modality for symptomatic paranasal sinus osteomas. However, the optimal surgical approach and the extent of the surgery, as well as the management stance in the case of an asymptomatic tumor, remain controversial.
METHODS
The MeSH terms 'Osteoma', 'Nasal Cavity', and 'Paranasal Sinuses' were used to retrieve articles concerning the management of paranasal sinus osteomas that were published in the last 30 years, the vast majority of which comprised case reports of one or two cases. Original articles or large series of more than six cases were prioritized.
RESULTS
Our review summarizes previous findings and opinions relevant to the management of symptomatic and asymptomatic paranasal sinus osteomas. The recent shifts in trends of their management are thoroughly discussed. Currently, an extension of the lesion through the anterior frontal sinus wall; an erosion of the posterior wall of the frontal sinus; a far-anterior intraorbital extension; an attachment to the orbital roof beyond the midorbital point; and some patient-specific adverse anatomic variations that may restrict access, are considered strong contraindications to a purely endoscopic approach. On the grounds of this thorough review, a new grading system for frontal and frontoethmoidal osteomas is proposed to allow better conformity to recent advancements and current clinical, research, and educational needs.
CONCLUSION
Over the past 30 years, endoscopic techniques have emerged as the new standard of care for favorably located paranasal sinus osteomas. Nonetheless, open approaches remain indispensable for the management of the more perplexing cases of frontal sinus osteomas.
Topics: Asymptomatic Diseases; Endoscopy; Female; Humans; Male; Nasal Surgical Procedures; Osteoma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Surgical Flaps
PubMed: 33799138
DOI: 10.1016/j.amjoto.2020.102644