Strategy for surgical excision and primary reconstruction of giant frontal sinus osteoma

Abstract

Background: Huge craniofacial tumors represent a real challenge to surgeons from several aspects; total excision of tumor, preservation and restoration of physiological functions of sensitive organs in the region, acceptable cosmetic outcome, and avoidance of complications. Tumors larger than 30 mm in diameter are considered giant tumors. The objectives of surgery in such tumors are to overcome those challenges. Case Description: In this article we present a 22-year-old female patient with a huge frontal sinus osteoma, probably the largest reported in the literature so far, measuring 10 cm × 8 cm × 8 cm, and causing recurrent peri-orbital cellulitis and severe disfigurement of the face. It took us 3 months of multidisciplinary preoperative planning for surgical excision of the tumor and 1ry reconstruction using custom-made PEEK prosthesis. Surgery went smoothly, the postoperative hospital stay was short (22 days), and there were no postoperative complications. Histology confirmed cancellous (sponge) osteoma. The outcome was excellent and satisfactory for both patient and the surgeons. Conclusions: Giant osteoma can be safely removed by craniotomy, planning and simulation of surgery on 3-D skull model, and preparing custom-made prosthesis, preferably titanium, for primary reconstruction is the key for successful treatment of such challenging tumors with good outcome.

Keywords

• Giant osteoma
• Craniofacial tumors
• Frontal sinus
• Craniotomy
• Custom-made prosthesis
• Reconstruction