Osteomas are slow-growing tumors of the paranasal sinuses, usually found in the frontal and ethmoidal sinus. In many cases, these tumors are discovered by chance or after an imagistic exam for a non-responsive to medical treatment headache. In asymptomatic tumors, conservative treatment is indicated, while in big tumors with complications the gold standard is surgical resection of the tumor. We present two cases of rather similar anterior ethmoidal osteomas in which the therapeutic management was decided according to the symptomatology of the patient and the imagistic CT exam. We decided different ways of treatment for the two cases based on the CT scan, which has a major role in predicting intraoperative complications during endoscopic sinus surgery.
Morphological variability of paranasal sinuses is well known for endoscopic surgeons and anatomists alike. The ethmoid sinus is the most complex and variable of all paranasal sinuses, due to the fact that its development is not yet well known and is influenced by many factors. Volumetric studies of the sinuses have been made using dried skulls, cadaver heads and imaging studies, but there are still not sufficient data in order to name a standard value for each sinus. Few data can be found especially regarding the ethmoid sinus. In this paper, we measured the volumes of ethmoid lateral masses, and for anterior and posterior groups of cells, using imaging studies and a volumetric feature of our imaging studies. Results showed an average volume between 7.34 cm3 and 8.39 cm3 for the ethmoid lateral mass, between 4.33 cm3 and 4.92 cm3 for the anterior ethmoid and between 3.01 cm3 and 3.47 cm3 for the posterior ethmoid groups. We also found that the average volume of the anterior ethmoid occupies between 58-59% of the whole volume, while the posterior ethmoid occupies only 41-42% of this volume.
Graves ophthalmopathy, an autoimmune disease, associated with hypermetabolism, enlargement of the thyroid gland and exophthalmia are the most frequent expressions of Graves’ disease, which often require surgical treatment. We present the case of a 41-year-old male with severe Graves ophthalmopathy for which we performed an endoscopic orbital decompression with good surgical outcome, the patient being discharged after 48 hours.