An unusual encounter in ophthalmology: Fronto-Ethemoido-Orbital Osteoma with the art of precise referral and management of PEEK implant infection- A rare case report

Abstract

Purpose: We present a rare case of a giant fronto-ethmoidal osteoma with orbital involvement, managed through a multidisciplinary approach. This case also highlights the prompt reconstruction using a PolyEtherEtherKetone (PEEK) patient-specific implant (PSI) and the subsequent management of a PEEK implant infection. Observation: We present a case of 34-year-old gentleman presented with progressive painless proptosis of left eye along with left sided headaches that he noticed for one year. CT scans suggestive of a large Fronto-Ethemoido-Orbital Osteoma seen to compressing the globe and superior rectus muscle. A multidisciplinary approach was chosen including an oculoplastic surgeon, maxillofacial surgeon and neurosurgeon to manage the case. A PEEK implant was used for the reconstruction of frontal and orbital bones, which later on got infected and a second surgery was done to explant the PEEK implant. Conclusion and importance: Asymptomatic osteomas without any orbital extension seldom requires any treatment. While secondary orbital invasion is relatively rare, it is more frequent in ethmoid, fronto-ethmoid, and frontal locations. Prompt treatment is crucial in the cases with orbital symptoms. In ophthalmology, there is a growing interest in using PEEK implants. While standard implants are usually adequate for routine repairs, complex cases with irregular defects or volume deficiencies present challenges. In these situations, patient-specific implants (PSIs) offer an invaluable solution.

Keywords

• Fronto-ethemoidal osteoma
• Orbital reconstruction
• PEEK implant
• Patient specific implant