Ethmoid labyrinth osteoma: case report

Osteomas are common benign slowly growing neoplasms that make up a group of osteogenic tumors, occurring mainly in the lower jaw and the sinonasal region with the involvement of the frontal sinuses in 80–96%, an ethmoid labyrinth in 2–15%, maxillary in 2–5% of cases, and extremely rarely – sphenoid sinuses. Among all benign tumors of the paranasal sinuses, osteomas occur in 3–10% of patients. The tumor can have a different density, as well as grow both on a pedicle and on a broad base, which makes it difficult to extract, especially when located in the frontal sinus. There is also a risk of developing liquorrhea when the osteoma adheres to the base of the skull. Patients and methods: Patient G., 67 years old, with complaints of impaired nasal breathing, postnasal leakage of mucous discharge into the pharynx, and recurrent headache localized in the frontal region, was admitted for planned surgical treatment to the otorhinolaryngological department of the Clinical Medical Center of the Evdokimov Moscow State Medical University. The listed symptoms have been noted over the past year. A computed tomogram of the head revealed a picture of an osteoma of the ethmoid sinus on the right, adjacent to the base of the skull in the area of the lateral lamella of the middle turbinate. Results: A transnasal endoscopic approach to the roof of the ethmoid labyrinth was performed by removing the middle turbinate, resecting the ethmoid bulla. After removal of the tumor, a naked area of the dura mater and pinpoint liquorrhea were visualized. Plastic surgery of the skull base defect was performed using several layers of biodegradable hemostatic material. Conclusion: Osteoma of the paranasal sinuses is a well-visualized tumor on a computed tomography, which usually does not require histological confirmation. At the same time, surgical treatment of this type of tumor may be accompanied by difficulties in their extraction, when located in the frontal sinus, as well as the risk of liquorrhea, when adhering to the base of the skull, which requires the surgeon to have skills in closing defects of the skull base and knowledge of the features of postoperative management.