Frontoethmoidal and intraorbital osteomas: exploring the limits of the endoscopic approach

Objective: To review our experience with the surgical treatment of frontoethmoidal osteomas, focusing on the osteomas that were either localized laterally in the frontal sinus or showing intraorbital involvement. Design: Retrospective evaluation. Setting: Tertiary care center. Patients: Patients with symptomatic frontoethmoidal or intraorbital osteomas who had been treated surgically from 1996 through 2011. Intervention: Sixty frontoethmoidal osteomas were treated surgically. The lesion involved the far lateral portion of the frontal sinus in 23 cases and the orbital region in 6 cases. In 31 cases, a purely endoscopic approach was performed while a combined procedure was used in 25 patients. In 4 patients, an exclusively external approach was required. Main Outcome Measure: No recurrence of osteoma. Results: Radical resection was obtained, except in the case of 2 lesions. No osteoma recurrence was observed during a mean follow-up of 72.6 months. Conclusions: Thesize of the osteoma, far lateral extension of the tumor in the frontal sinus beyond the lamina papyracea, and intraorbital involvement are no longer absolute contraindications for purely transnasal endoscopic resection. What is important is that the surgeon should not be dogmatic but rather be ready to change his or hermind during surgery, shifting to an external approach when required.