Orbital osteoma: clinical features and management options.

Mark Lucarelli // Publications // Mar 01 2014

PubMed ID: 24614547

Author(s): Wei LA, Ramey NA, Durairaj VD, Ramakrishnan VR, Cruz AV, Dolman PJ, Lucarelli MJ. Orbital osteoma: clinical features and management options. Ophthalmic Plast Reconstr Surg. 2014 Mar-Apr;30(2):168-74. doi: 10.1097/IOP.0000000000000039. PMID 24614547

Journal: Ophthalmic Plastic And Reconstructive Surgery, Volume 30, Issue 2,

PURPOSE This study reviews the clinical presentation and management of 11 cases of sino-orbital osteoma.

METHODS The medical records of patients with primary (originating from orbital bone) and secondary (originating from the paranasal sinuses) orbital osteoma from the academic practices of 4 surgeons (A.V.C., M.J.L., P.J.D., V.D.D.) were reviewed for clinical presentation and course, pathologic study, and radiologic reports. A Medline search of English-language literature on orbital osteomas was conducted for comparison with these findings.

RESULTS Eleven cases of primary (1) and secondary (10) orbital osteoma were reviewed, with a mean follow up of 16 months. Seven patients were women. Ages ranged from 15-68 years, with a median of 40 years. Presenting complaints included slowly progressive globe displacement, palpable bony nodule, pain, and diplopia. Surgery was performed in 10 cases. Surgical approach varied according to location and size of each lesion and was performed in combination with otolaryngology and neurosurgery services as needed. Reconstruction included sculpting osteomatous bone to natural orbital contours, repair of orbital wall defects with implants, and obliteration of frontal sinus. Lesions demonstrated mixed compact, cancellous, and fibrous histologic subtypes.

CONCLUSIONS Osteomas are the most common tumor of the paranasal sinuses (noted in up to 3% of coronal CT images), but secondary extension in or primary involvement of the orbit is rare. A variety of surgical approaches led to successful outcomes in this series. Complete surgical removal is not always necessary, and partial sculpting may relieve symptoms and cause less surgical morbidity in selected cases.