Osteoma

An osteoma is a new piece of bone usually growing on another piece of bone, typically the skull. It is a benign tumor. When the bone tumor grows on other bone it is known as “homoplastic osteoma”; when it grows on other tissue it is called “heteroplastic osteoma”.

Osteoma represents the most common benign neoplasm of the nose and paranasal sinuses. The cause of osteomata is uncertain, but commonly accepted theories propose embryologic, traumatic, or infectious causes. When symptoms are present, they vary according to the osteoma’s location within the head and neck, and they usually are related to compression of the cranial nerves. Such symptoms may include disturbances in vision and hearing and cranial nerve palsies. Larger craniofacial osteomata may cause facial pain, headache, and infection due to obstructed nasofrontal ducts.

To diagnose an osteoma, your doctor will conduct a physical exam and ask about any symptoms you are experiencing. However, most osteomas don’t cause any symptoms. Osteomas have a characteristic appearance on CT scans. Bone scans may also be used to confirm diagnosis.

Treatment of osteomas is only necessary if they are symptomatic. Large osteomas should be evaluated to rule out other diagnoses. The most common treatment option for osteomas is surgery on the skull base. Osteomas of the skull base may be approached directly using endoscopic sinus surgery. This minimally invasive approach allows surgeons to access the tumor through the natural corridor of the nose, without making an open incision. Surgeons then remove the osteomas through the nose and nasal cavities.

Case Example 1:

64-year-old male had a history of recalcitrant frontal sinusitis who then developed intermittent periorbital cellulitis, as well as a fistula tract from the sinuses to the skin with purulent material draining from it. MRI and CT scan demonstrated a very large frontoethmoidal stoma on the left-hand side that had completely obstructed his left frontal sinus.

This obstruction, coupled with the fact that the patient did not typically develop any headaches or symptomatic problems from sinusitis, was an indication that the mass had likely been there for a long period of time and had eroded the bone along the orbit, causing intermittent cellulitis and a repairable fistula. The patient underwent an extensive opening of all his sinuses and the tumor, which is a benign bone tumor, was drilled out of his frontal sinus. After removal, the patient healed up well and has no evidence of regrowth of tumor or blockage of his sinuses.. He now has yearly visits and CT scans.

Case Example 2:

20-year-old male who had a history of right eye tearing and saw an ophthalmologist who recommended a CT scan, this scan revealed a right nasal mass along his right tear duct. The patient denied any facial pressure, pain, headaches, nasal obstruction, nasal drainage and vision changes.

He underwent an endoscopic resection and is doing well post operatively. He routinely does Pulmicort and saline nasal irrigations and is asymptomatic.