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

Ethmoid osteoma is a slow-growing, benign, and encapsulated bony tumor. Symptoms occur earlier than with osteomas of the frontal sinus because of the small volume of the ethmoid sinus. Interestingly, orbital extension is uncommon. Treatment remains controversial, with open procedures typically being used. In this article, we present a less invasive yet safe and effective approach to treatment.

A nasoendoscopic approach using a Stammberger-Saches intranasal drill was developed for treatment of patients with ethmoid osteoma, with or without orbital extension. Between 1995 to 1999, seven patients underwent the new surgical procedure.

All procedures were performed under general anesthesia. Using 0 degrees and 30 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 osteoma medially toward the nasal septum. With alternate drilling and elevation, the osteoma was gently removed. The surgical site was then packed.

The method successfully treated all patients. There were no major complications. 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 months after surgery.

The 30 degrees nasoendoscopic approach using an intranasal drill provides a good operative field and is a safe and effective technique, with the potential to become the treatment of choice in selected cases.