ABSTRACT
OBJECTIVE: To present the first report of a giant frontal sinus osteoma treated by excision and single-stage reconstruction with custom-made titanium cranioplasty and left orbital roof prostheses. CASE REPORT: A 31-year-old man with a history of chronic frontal sinusitis presented with a deforming, painless, midline forehead swelling of 11 years' duration, which had been treated unsuccessfully in Nigeria. Differential diagnosis included both benign and malignant bony tumours. Computerised tomography revealed a giant bony frontal sinus tumour extending beyond the sinus roof and breaching the left orbit, consistent with fibrous dysplasia. Given the extent of the tumour, open craniectomy was performed for surgical extirpation. Histological analysis identified multiple osteomas. This surgical approach achieved excellent cosmesis, with no evidence of recurrence at 12-month follow up. CONCLUSION: Forehead swelling may pose diagnostic and management dilemmas for the ENT surgeon; however, effective management is facilitated by a multidisciplinary approach.
Subject(s)
Fibrous Dysplasia of Bone/diagnosis , Frontal Sinus/pathology , Osteoma/diagnosis , Adult , Bone Neoplasms/diagnosis , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Diagnosis, Differential , Fibrous Dysplasia of Bone/pathology , Fibrous Dysplasia of Bone/surgery , Frontal Sinus/surgery , Frontal Sinusitis/pathology , Frontal Sinusitis/surgery , Humans , Male , Orbit/pathology , Osteoma/pathology , Osteoma/surgery , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/pathology , Paranasal Sinus Neoplasms/surgery , Prostheses and Implants , Plastic Surgery Procedures/methods , Titanium , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: We report the rare case of a 55-year-old woman with an asymptomatic left sphenoid sinus pseudomeningocele mimicking a mucocele. CASE REPORT: A 55-year-old woman was found to have an incidental mass in the left sphenoid sinus on computed tomography. Magnetic resonance imaging confirmed the presence of a mucocele. A left endoscopic sphenoidotomy was performed to drain the mucocele. Despite an anatomical puncture through a stenosed sphenoid ostium, alarmingly, the opening leaked cerebrospinal fluid. A dehiscent lateral wall was identified with a dural opening communicating with the sphenoid sinus. This was immediately repaired with a free nasal septal mucosal graft. Six months post-operatively, the patient remained free from cerebrospinal fluid leakage. CONCLUSION: Pseudomeningoceles are extremely rare in the absence of trauma or iatrogenic injury. Surgeons should be alert to their presence as they can mimic a unilateral mucocele or nasal polyp. Endoscopic management lends itself to a single-stage repair.
