Inverted papilloma nasal cavity
Figure 5. Drainage tube through the frontal recess The histopathologic examination confirmed the diagnosis of left frontal sinus osteoma.
The postoperative evolution was favorable. The patient received i. Daily dressing change was performed, inverted papilloma nasal cavity well as aspiration through and around the drainage tube.
The postoperative ENT reevaluation was performed after 14 days Figure 6at one month, at three months, and at six months. Figure 6. ENT reevaluation at 14 days after surgery Discussion Osteoma is the most common tumor of paranasal sinuses, often with a slow and silent evolution. The most frequently involved site is frontal sinus, followed by ethmoid and maxilar sinuses. The sphenoid sinus is rarely involved 1,2. In general, the flatulenta hidrogen sulfurat of osteomas may vary between 2 and 30 mm.
Osteomas bigger than 30 mm or the ones weighing more than g are considered to be giant 4. The etiology of osteomas inverted inverted papilloma nasal cavity nasal cavity still unknown.
Several hypotheses have been taken into consideration: traumatic or infectious triggers, calcium metabolism disorders, or embryonic malformations 5. Frontal sinus osteoma grading system 6 Grade I. The base of attachment is posterior-inferior along the frontal recess.
Polipoză de sinus frontal operată prin abord endoscopic transcranian
The tumor is medial to a virtual sagittal plane through the lamina papyracea. Grade II. Grade III. Grade IV. Tumor fills the entire frontal sinus the current case.
Osteomas are white, hard, well circumscribed, round or oval, sesile rarely pediculatedbosselated tumors. Histologically, osteoma is composed of lamellar, mature bone with haversian-like systems, surrounded by fibrous, paucicellular stroma 7.
Corelaţii anatomoclinice şi imagistice CT în patologia rinosinuzală.
The diagnosis of osteoma is established by clinical and paraclinical exams. The patients may complain of persistent frontal pain unresponsive to analgesic or antiinflammatory inverted papilloma nasal cavity, hemifacial pain, rhinoreea and nasal obstruction. Computed tomography of the head and paranasal sinuses is the gold standard for the diagnosis of osteoma and is also necessary for its management.
MRI is useful when intracranial extensions are suspected 8. The management of the frontal sinus osteoma depends on the severity of the symptoms and the extension of the tumor. If chronic sinusitis unresponsive to treatmentpersistent headaches when all other causes have been excluded or mucocele occur, the therapeutic approach is surgical.
It can be external, endoscopic or combined: external for the removal of the tumor, and endoscopic to provide the appropriate drainage from the frontal sinus. The approach depends mostly on the site and dimension of the osteoma.
Sometimes, there are cases of small frontal recess osteomas which can be approached only by endoscopic approach. The definitive diagnosis of osteomas can be established only after the histological examination of the tumor. If osteoma is big, extending inverted papilloma nasal cavity the sinus wall to the intracranial space, a multidisciplinary surgical approach will be mandatory: otorhinolaryngologist and neurosurgeon. The postoperative complications which may occur are: subcutaneous emphysema, persistent suppurative sinusitis, fistulization, frontal osteomyelitis, supraorbitar nerve branches damage, supraorbitar neuralgia, ecchymosis, palpebral edema, dyplopia, inverted papilloma nasal cavity, frontal recess stenosis, recurrence of frontal sinusitis, and tumoral recurrence.
The current case had a classic, slow onset and progression, affecting a middle aged female patient. The symtoms have occured gradually: progressive headache started 12 months before the admission to the hospital.
The presumptive diagnosis was established after clinical and inverted papilloma nasal cavity examinations transnasal endoscopy, native computed tomography of the head and paranasal sinuses. The definitive diagnosis was established by the histological examination of the tumor. Considering the size of the tumor 4th grade, taking into consideration the classification of osteomas mentioned abovethe decision regarding the therapeutic approach was taken and the combined approach surgery was performed: external and endoscopic, which allowed the ablation of inverted papilloma nasal cavity tumor, as well as proper postoperative drainage of frontal inverted papilloma nasal cavity.
Due to the early diagnosis of the osteoma, no complications have been noticed, the evolution being favorable. ENT postoperative reevaluations performed after one month, three months, six months and 12 months did not reveal any tumoral recurrence. Conflict of interests: The authors declare no conflict of interests. Paranasal sinus osteomas. J Craniofac Surg.
EBSCOhost | | Managementul papilomului inversat din sinusurile paranazale.
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