Resection and Reconstruction of a Giant Paranasal Osteoma in a Pediatric Patient

Abstract

Case Report. Paranasal osteomas are rare, benign bony tumors of the craniofacial skeleton and most are treated endoscopically without the need for reconstruction. In rare cases, open traditional craniofacial approaches are required with a paucity of literature describing extirpative maneuvers in this setting. We present a unique case of a rapidly growing, paranasal bony tumor in a pediatric patient and describe our surgical technique for resection and reconstruction. A 13-year old male presented with eight months of progressive, painless right periorbital swelling and proptosis. Trans-nasal biopsy confirmed an osteoma of the right ethmoid sinus and endoscopic resection was recommended. Due to interval tumor growth, there was worsening visual acuity that precluded a minimally invasive approach. Pre-operative and post-operative 3D computed tomography (CT) scans were completed, and a 3D printed skull model was produced to aid in surgical planning. A multi-disciplinary team of Otolaryngology, Neurosurgery, and Plastic Surgery was employed. The majority of the extirpation was performed with a highspeed carbide burr. Post-operative course was unremarkable and CT scan demonstrated a complete resection. Pathology confirmed the diagnosis of an osteoma. Six-month follow-up demonstrated normal ophthalmologic function and visual acuity with excellent aesthetic results. This is a rare, complex presentation of a paranasal osteoma that was successfully managed with an open, multi-disciplinary approach. We highlight pearls gleaned from this extirpative and reconstructive technique. Due to the tumor density and location, a multidisciplinary team, Stealth navigation, an open, intra- and extra-cranial approach and use of a highspeed carbide burr were essential.