ENDOSCOPIC REMOVAL OF A GIANT ETHMOID OSTEOMA WITH ORBITAL EXTENSION
A 45 year old male was referred to our hospitals’ emergency room with periorbital edema, exophthalmos, pain and decreased vision in the right eye. The eye movements were restricted to all directions and he has been complaining of right sided headache for the last 6 months. The patient underwent an ophthalmological assessment which revealed 2.5 mm of proptozis on right side with diplopia on both gazes, limitation of eye movements and exophtalmos. In our clinical examination we found a minimal septal deviation to the right and hypertrophy of the left inferior turbinate. No history of systemic medical diseases were present.\nComputed tomography of the paranasal sinuses and orbita showed a dense ossified mass which was 35x30x25 mm in size, originating from the posterior ethmoid air cells, extending to the anterior ethmoid air cells and the right orbita. It was pushing the right medial rectus muscle and right optic nerve from the medial side. Bulbus oculi was dislocated anteriorly (proptozis).\nUnder general anaesthesia, endoscopic sinus surgery was performed for the removal of the mass. Uncinectomy was performed, maxillary sinus ostium was identified and the ethmoid bulla was resected. After the anterior wall of the ethmoid bulla had been resected, the osteoma was fairly visualized as a hard, whitish mass strongly bonded to the medial wall of the orbit. The size of the tumour was too large to be taken out from the nasal cavity through neither the choana nor the piriform aperture. It was necessary to fragment it, so most of the tumor was drilled with the help of a burr and the rest was elevated and removed with the aid of forceps by way of piriform aperture. As seen on the CT, lamina papyracea was defective seperation, and the mass was elevated directly from the periorbital tissues.\nNose was lightly packed to prevent post-operative haemorrhage and they were removed 48 hours later. There was no defect at the cribriform plate and no perioperative complications like cerebrospinal fluid leakage, haemorrhage or loss of vision was observed.\nThe symptoms improved dramatically just after the operation, and the patient discharged two days after surgery without any complications.\nThe histopathological examination confirmed the diagnosis, ’osteoid osteoma’. The patient was followed-up with nasoendoscopy which confirmed re-epithelialization within 4 weeks of surgery. The HRCT sinus-scan performed 6 months postoperatively confirmed no residual osseus tumours.