Q: Dr. Eppley, I have developed an osteoma directly over the inside of my right brow bone. The osteoma developed approximately 15 years ago, and has steadily grown over time. Currently, it measures 0.9 cm x 2.5 cm transverse x 1.8 cm and extends into my right superior orbital rim. This is a benign osteoma. I was interested in Endoscoptic Osteoma removal. I was wondering if you thought it would be an option given the size and location of the Osteoma? If not what other procedure do you suggest. I hope you can help me. I truly appreciate your taking the time to look at the pictures. Thank you so much.
A: Thank you for your inquiry and sending your pictures. The first important question about your osteoma is its potential involvement with frontal sinus. Is it just located on the outer table of the frontal sinus or does it extend into and involve the frontal sinus air cavity?Since you provided such specific measurements you must have had a CT scan in which it was so measured. What does the CT scan show in this regard? Secondly, almost irregardless of whether it extends into the frontal sinus cavity or not, it removal will necessitate the anterior table of the frontal sinus to be removed and replaced (reconstructed) with normal bone. Simple burring it down will result in opening up the frontal sinus cavity, which would be impossible to fix through an endoscopic approach. If your osteoma was just about anywhere else it could be treated by a limited or endoscopic approach through burring or an osteotome…but not over the frontal sinus. This is going to necessitate an open scalp approach so it is removed under direct vision and the frontal sinus managed properly and a smooth brow bone contour is obtained. An open scalp approach means either a traditional scalp incision way behind the hairline or a pretrichial incision which is an irregular incision placed right at the frontal hairline. There are advantages and disadvantages to either incisional approach. I have done frontal sinus osteomas exactly identical to yours and they always involve the entire anterior table of the frontal sinus cavity wall and require some form of brow bone reconstruction.
Dr. Barry Eppley