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Case Reports
. 2014 Jun;34(3):205-8.

Endoscopic ultrasonic curette-assisted removal of frontal osteomas

A Bolzoni Villaret  1 , A Schreiber  1 , I Esposito  1 , P Nicolai  1
Affiliations
Case Reports

Endoscopic ultrasonic curette-assisted removal of frontal osteomas

A Bolzoni Villaret et al. Acta Otorhinolaryngol Ital. 2014 Jun.

Abstract
in English, Italian

Indications for endoscopic resection of fronto-ethmoidal osteomas have been progressively expanded thanks to optimization of surgical exposure and the development of dedicated instruments. Curved cutting drills are still suboptimal to treat hard osseous neoplasms of the frontal sinus. We present two patients affected by frontal osteoma treated with an endoscopic procedure using an ultrasonic bone curette. The ultrasonic bone curette may be considered an effective tool to reduce soft tissue manipulation, optimize surgical time and accelerate the healing process. However, the technique requires significant shape innovations to reach the lateral recesses and to manage pure intrasinusal lesions.

Le indicazioni alla chirurgia endoscopica nel trattamento degli osteomi fronto-etmoidali si sono progressivamente estese grazie all'ottimizzazione dell'esposizione chirurgica ed allo sviluppo di una strumentazione dedicata. Le frese curve sono ancora subottimali nel trattamento di lesioni ossee eburnee del seno frontale. Presentiamo due pazienti affetti da osteoma frontale trattati con procedura endoscopica utilizzando la curette per osso ad ultrasuoni. La curette ad ultrasuoni può essere considerato un efficace strumento chirurgico per ridurre la manipolazione dei tessuti molli e per ottimizzare i tempi chirurgici e del processo di guarigione. Tuttavia è necessario migliorare la forma dello strumento per premettere di raggiungere i recessi più laterali e gestire lesioni localizzate interamente nel seno frontale.

Keywords: Frontal sinus; Sinunasal osteomas; Ultrasonic curette.

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Figures

Fig. 2.
Fig. 2.
Preoperative CT scan of case 1 shows an osteoma (asterisk) occluding the right frontal recess. Note the remodelled lamina papyracea (arrows) and the lesion attachment over the posteroinferior aspect of the frontal sinus. Axial (A) and coronal (B) plane.
Fig. 3.
Fig. 3.
Intraoperative and postoperative endoscopic views of case 1. A: after lesion removal the mucosa of the lamina papyracea is partially maintained. B: Postoperative examination at 6 months with angled telescope highlights complete healing with no stenosis of the frontal recess.
Fig. 4.
Fig. 4.
Preoperative CT scan of case 2 shows an osteoma (asterisk) located in the right frontal recess and inserted at the anterolateral aspect of the right cribriform plate. Axial (A) and coronal (B) plane.
Fig. 5.
Fig. 5.
Intraoperative images of case 2. After lesion cavitation and dissection from surrounding structures, the residual shell of bone is further reduced with a four-hand technique (white asterisk indicates the frontal sinus). B: close-up view. Note the mucosa surrounding the lesion (black asterisk), which is spared by the device.
Fig. 1.
Fig. 1.
Schematic drawing shows the position of the device running over the angled endoscope. Head extension improves the working angle.
See this image and copyright information in PMC

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