351/387. Use of surgical laser in the removal of an osteoma of the skull. The laser beam can be adapted for use as a surgical cutting instrument. It was chosen for this purpose in the extirpation of an osteoma of the skull. Its removal by conventional means was believed to be too dangerous, because of surrounding vascularity. The nature and properties of the beam and its surgical applications are discussed briefly. ( info) |
352/387. Gardner's syndrome. Report of three cases and review of the literature. Three cases of Gardner's syndrome are reported. Two patients had one and two carcinomas in the colon respectively. Postoperatively the two patients developed desmoid tumours in the abdominal wall, and one of them also an intraabdominal desmoid. The literature is briefly reviewed with respect to diagnosis and treatment of the components of the syndrome. A special section is devoted to the differentialdiagnostic problems. The reports from the last years concerning this problem are surveyed, and the rationale for maintenance of Gardner's syndrome and familial polyposis of the colon as two different genetic entities is questioned. ( info) |
353/387. life threatening intracranial complications of frontal sinus osteomas: report of two cases. paranasal sinuses osteomas are known as biological benign tumours. However, due to the peculiar anatomical relationships, patients harbouring an osteoma within the frontal sinus are exposed to serious orbital and intracranial complications. We report two unusual cases of intracranial mucocoeles associated with frontal osteomas. In one of them, a superposed tension aerocoele required emergency surgery. Although aggressive treatment of asymptomatic osteomas is not warranted, these lesions must be carefully observed and resected as soon as they show clinical and/or radiological signs of progression. The physiopathological and clinical aspects are discussed. ( info) |
354/387. osteoma of the promontory: a case report. Osteomas of the middle ear are rare lesions. We report the case of a 20-year-old male with osteoma originating from the promontory coincident with tympanic membrane perforation. Histopathological diagnosis was performed by means of a superficial curettage during surgery, to avoid a cochlear fenestration. Postoperative closure of the air-bone gap after myringoplasty confirmed the presumed asymptomatic nature of these lesions. ( info) |
355/387. Frontal exostose resection during an endoscopic subperiosteal lifting: case report. Ever slowly, plastic surgery has adopted minimally invasive procedures in order to avoid extensive incisions, large scars, and to obtain better results. endoscopy was introduced into cosmetic surgery of the face in 1992 and it is getting more and more widespread as are its indications, often replacing open surgical approach. Sometimes, a patient seeking a solution to the stigma attached to the aging face may present other problems that are surgically treatable. The authors describe a case of surgical endoscopic resection of a frontal osteoma during endoscopically assisted brow-lift rhytidoplasty. ( info) |
356/387. Treatment of frontal sinus osteoma using a craniofacial approach. osteoma is one of most common benign tumors of the nose and paranasal sinuses, with the frontal sinus being its most frequent location. It may be locally destructive and aggressive with possible intracranial complications. osteoma of the frontal sinus comprises 57% of all osteomas in the paranasal sinuses. In 1939, Childrey reviewed 3,510 consecutive sinus radiographs taken for any reason and found an incidence of 0.43% of paranasal sinus osteomas. There are many operative approaches for frontal sinus osteomas, such as external frontoethmoidal approach and osteoplastic frontal sinusectomy, both with high recurrence rates. Those traditional operative methods cannot radically eradiate the osteoma grown in the posterior table of the frontal sinus. From July 1991 to June 1992, three patients with symptomatic frontal sinus osteomas were operated by a craniofacial approach. One patient is presented here in detail. A coronal incision is used and is found to be beneficial both in surgical exposure and in reconstruction with a calvarial bone graft. The patient has been followed for 3.5 years without osteoma recurrence. ( info) |
| Paranasal sinus osteomas are benign tumours, occasionally known to cause complications. They have a tendency to grow slowly, but the growth rate has never been evaluated previously. We retrospectively studied 44 patients with paranasal sinus osteomas. In 13 out of the 23 patients who underwent at least two sinus radiographs at different times some growth was seen. The mean growth rate of these 13 osteomas was 1.61 mm/yr, range 0.44 to 6.0 mm/yr. The endoscopic technique is a good method for the removal of osteomas and obliteration of the frontal sinus does not seem to be necessary. Two patients having osteomas with intracranial expansion are described. ( info) |
358/387. Fronto-ethmoid osteoma: the place of surgery. Osteomas of the paranasal sinuses are common. Most are, however, asymptomatic and a chance radiographic finding. We describe four cases histories which help to illustrate the benefits and hazards of surgery, and highlight the importance of patient selection. A review of the literature is presented. ( info) |
| BACKGROUND: Choroidal osteoma is a rare choroidal tumor; knowledge of its indocyanine green characteristics is limited. methods: The fundus photographs and the fluorescein and indocyanine green angiograms of three patients were reviewed. Each patient was examined at least twice with a follow-up varying from 10 to 60 months. RESULTS: Late-phase fluorescein angiograms allow assessment of the extension of the osteoma as it is variably hyperfluorescent due to tumor staining combined with a variable degree of overlying retinal pigment epithelial changes. The hypofluorescent area observed in the early phase of the indocyanine green angiogram corresponds with the extent of the osteoma but the borders may be difficult to demarcate. In the late phase of the indocyanine green angiogram, hypofluorescence due to choriocapillaris loss and hyperfluorescence due to leakage from abnormal choroidal vessels are combined. Infrared angiography high-lights abnormal choroidal vessels and vascular spiders present on the tumor surface. It is difficult to differentiate these choroidal vascular anomalies from subretinal neovascularization. CONCLUSIONS: We find no homogeneous pattern either on fluorescein or on infrared angiography. The findings may change with follow-up, indicating changes within the tumor or the surrounding tissue that are still poorly understood. ( info) |
360/387. Multiple, juxtasutural, cranial hyperostoses and cardiac tumor: a new hamartomatous syndrome? We report on a Japanese girl with multiple cranial hyperostoses and a cardiac tumor, both of which manifested in early childhood. Unique juxtasutural lesions characterized the cranial findings, including a chain of almost symmetrical osseous protuberances involving the frontozygomatic and frontoparietal junctions, and discrete bony bumps on the right occipitoparietal junction and left temporo-occipital junction. These lesions histologically consisted of thickened mature bone intervened with sparse fibrous tissues, mimicking osteoma. The cardiac mass remained pathologically unknown, but was shown to have fatty elements on magnetic resonance imaging (MRI). The patient showed no evidence of gnathic hyperostoses, ophthalmological abnormalities, skin lesions, or other visceral abnormalities, which ultimately precluded known hamartomatous syndromes with craniofacial hyperostoses, such as Gardner and Proteus syndromes. Yet regional proteus syndrome could not be completely excluded. The craniofacial deformity as a sequel of hyperostoses in our patient superficially resembled that of X-linked calvarial hyperostosis; however, the vacuolated histiocytes that characterized the hyperostotic lesions were not found in our patient. The present disorder may represent a hitherto unknown hamartomatous syndrome. ( info) |