A spectrum of rare osseous neoplasms originating from the bony framework of the head and neck in children including osteomas, ossifying fibromas, and fibrous dysplasia are reviewed. Special attention is given to radiographic evaluation, clinical presentation, histological appearance, and surgical management. This study reviews the outcomes and complications of various surgical approaches. Indications for an endoscopic sinus surgery approach and the benefits of computer image guidance are highlighted.
Methods
The rare presentation of these bony lesions makes prospective studies very difficult. This study compares experience at a tertiary referral children’s hospital with those presented in the literature. Clinical presentations, indications for treatment, surgical options, and relevance of computer image guidance are reviewed.
Results
Osteoma is the most common benign neoplasm of the sinonasal cavity. Surgical excision is the procedure of choice, which may vary from external approaches to endoscopic sinus surgery. Surgical indications include pain, obstructive symptoms, cosmesis, and intracranial complications. There exists a trend toward endoscopic approaches due to advances in instrumentation. The presenters’ experience and a large body of case studies in the literature confirm the safety of endoscopic sinus surgery with and without image guidance in the excision of certain paranasal sinus osseous neoplasms.
Conclusions
The recent popularity of computer image guidance has enhanced the utility of endoscopic sinus surgery for operative excision of these bony lesions, and endoscopic sinus surgery with or without image guidance proves to be a safe approach to complete tumor resection with the benefit of reducing surgical complications.
FULL TEXT