Endonasal endoscopic resection of ethmoido-orbital osteoma compressing the optic nerve

Osteomas are the most common benign tumors of the paranasal sinuses. Open procedures for removal of ethmoid osteomas have been the method of choice, but debate over optimal treatment continues. We report resection of a large ethmoido-orbital osteoma via endonasal endoscopic approach with minimal morbidity. A 42-year-old man presented with a 1-year history of slowly progressive proptosis and lateral gaze diplopia. Imaging studies of orbits and sinuses revealed a large bony mass in left ethmoid sinus extending into the left orbit. The mass had compressed and slightly diverted the optic nerve. The patient had also bilateral extensive polyposis for which bilateral ethmoidectomy and sphenoidotomy were performed. Using a curved blunt elevator, the osteoma was gently and meticulously detached from adjacent structures. Finally, frontal recesses were cleaned form the polyps. The postoperative period was uneventful. After 18 months, he is still free of symptoms. The previously used management modality of symptomatic osteomas has mostly consisted of open approaches. Endonasal endoscopic approach provides a safe and effective alternative to open approaches, offering cosmetic advantages and lowering the morbidity. This approach could be judiciously used in large ethmoido-orbital osteomas in selected cases.