Osteoma of the frontal sinuses. Symptoms, diagnosis and treatment of tumors of the facial skeleton

Cells of human physiological tissues undergo various disorders over time, the result of this process is the formation of tumors. They are divided into malignant and benign. If the first type negatively affects the activity of the body, then the second has virtually no effect on the functioning of its systems. Osteoma of the frontal bone can be associated with these neoplasms.

A benign skeletal neoplasm or osteoma develops and grows very slowly and almost never turns into a malignant tumor. It is formed on the bones of the skull, the skeleton of the face, the humerus and femurs, and can also be located on the terminal phalanges of the toes, usually the big ones.

According to one classification, osteomas are distinguished:

• hard;
• medullary.
• spongy.

According to another classification, they are divided into two types:

• heteroplastic, developing from the connective tissue of the skin;
• hyperplastic, developing from bone tissue.

Osteoma is usually easy to detect in various parts of the skull from the outside, and sometimes it develops inside the bone. Cranial tumors are usually located in the occipital or frontal bones and the walls of the maxillary sinuses.

In the head region of the skull, osteoma is formed from hard bone tissue, and from spongy substance - in spongy bones.

Causes

There are two theories for the origin of osteomas: from the remnants of embryonic cartilage or from the periosteum of mature bone. In some cases, the occurrence of osteomas is associated with an inflammatory process or injury Source: Toropova I.A. Features of the clinical course of osteoma of the nose and paranasal sinuses / I.A. Toropova // Bulletin of RUDN University. — Medicine Series. - 2005. - No. 1(29). — P. 95-97. .

It is believed that the development of osteomas is also facilitated by:

• injuries;
• hypothermia;
• inflammation and previous infections;
• some diseases (rheumatism, gout, syphilis);
• genetic predisposition.

Polyp in the ear

Benign polyps of the ear include polyps. These are neoplasms that arise as a result of the proliferation of granulation tissue. The polyp may be located in the external auditory canal or middle ear. Neoplasms localized in the ears can spread to other parts of the skull.

Most often, a polyp is a complication of a chronic inflammatory process in the ear. At the site of chronic inflammation of the mucous membrane, a gradual proliferation of tissue occurs, replacing normal tissue with connective tissue. When the pathological process is localized in the middle ear, the formation can remain invisible for a long time to conventional otoscopy. As the polyp grows, it “falls out” into the external auditory canal through the perforation of the eardrum.

A polyp in the ear is manifested by the following symptoms:

• Suppuration, sometimes mixed with blood (stopping the flow of pus can be caused by blockage of the ear canal by a polyp);
• Itching, noise and pain in the ear;
• A feeling of constriction, the presence of a foreign body in the ear cavity;
• Decreased or loss of hearing;
• Headaches.

In the absence of adequate treatment, a polyp caused by an infection in the ear often becomes the cause of chronic otitis media, supports the inflammatory process and prevents the penetration of drugs to the site of infection. The growth of the polyp leads to blockage of the ear canal and deafness. Under certain conditions, there is a risk of its degeneration into a malignant tumor.

For polyps of small size, in some cases, otolaryngologists carry out conservative treatment with creams containing glucocorticoids and antibacterial drops. If the disease is fungal in nature, antifungal drugs are used. The main treatment for a polyp in the ear is surgery.

The polyp is cut off on an outpatient basis with a special loop or using another instrument: a curette, an ear conchotome. Radical surgery is performed in a hospital. The operation is performed if the fistula is localized in the semicircular canal. An alternative treatment option is laser removal of polyps. A modern method of treating a polyp in the ear is OTO NUS therapy in combination with endoural LILI (exposure to the pathological focus with low-frequency ultrasound through various medicinal solutions).

Symptoms

The symptoms of a tumor depend on where it is located. But a number of clinical signs stand out:

• located on flat, tubular bones, vertebrae, in the walls of the paranasal sinuses, on the surface of the skull;
• immobility;
• density;
• with a smooth surface;
• with clear boundaries;
• does not hurt when pressed.

Osteoma may not make itself felt for a long time and not interfere, but if it grows too large, it begins to put pressure on neighboring tissues and bones, which causes the corresponding symptoms:

• pain;
• if the tumor is in the nasal paranasal sinuses, drooping of the eyelid (ptosis), blurred vision, etc.
• memory problems, epilepsy (if located on the inner surface of the skull);
• lameness (if localized on the bones of the legs);
• nosebleeds, difficulty breathing (if the tumor is located in the maxillary sinus area).

Table of symptoms, depending on the location of the tumor

Classification

Osteoma

Depending on the type of structure of tumors, they are distinguished:

• Hard compact osteoma formed by dense compact bone tissue.
• Spongy osteoma - formed by a porous spongy substance with cavities filled with fibroreticular tissue.

In relation to the bone organ, there are periosteal osteomas, located on the outer surface, and endosteal osteomas, located on the inner surface of the bone (Fig. below).

Osteoid osteomas

Based on localization in the bone (radiologically), several types of osteoid osteoma are distinguished: medullary, cortical, subperiosteal and protruding into soft tissue.

Types of osteomas

Depending on the origin of osteomas, there are:

1. Heteroplastic
   - formed from connective tissue. This includes osteophytes. They are found not only on bones, but in soft tissues and organs - in the diaphragm, tendon attachment points, lining of the heart, etc.
2. Hyperplastic
   - formed from bone tissue. This group includes osteoid osteomas and osteomas.

Let's look at the subspecies that belong to two main groups.

1) Internal and external osteophytes

.

• The internal ones are called “enostoses”, they grow into the bone marrow canal. Usually solitary, except for osteopoikilosis. They do not produce symptoms and are usually discovered incidentally when a person has an x-ray.
• External ones are called “exostoses”. They grow on the surface of the bones and can appear for no reason or due to certain pathological processes. Causeless exostoses usually appear on the bones of the skull, facial and pelvic bones. They may not cause symptoms and may only be an aesthetic defect or put pressure on neighboring organs. In some cases, a fracture of the exostosis leg occurs and bone deformation occurs.

2) Osteoma

– does not differ in structure from bone tissue, usually found on the facial and cranial bones, including the paranasal sinuses. Bone osteoma is diagnosed twice as often in men, in the area of ​​the facial bones – three times more often. These are almost always single tumors, but with Gardner's disease multiple tumors can grow on long bones. They are painless and do not cause symptoms, but when adjacent structures are compressed, various symptoms appear. Separately, there are multiple congenital osteomas of the cranial bones, which are combined with other developmental defects.

3) Osteoid osteoma

– highly differentiated bone tumor. However, it has a different structure - it consists of vascular-rich elements of osteogenic tissue, zones of bone tissue destruction, and bone beams. Usually there is no pain 1 cm in diameter. It is a common disease, accounting for approximately 12% of all benign bone tumors.

Is osteoma dangerous?

Speaking about the dangers of osteoma, one should note first of all the compression of neighboring organs and symptoms that cause inconvenience to the patient. If the tumor does not manifest itself and does not grow, it can be left in place. A neoplasm of this kind never develops into malignant – there is no need to be afraid of cancer. Tumors on the head should be treated with particular care - they not only cause unpleasant symptoms, but can also lead to a brain abscess. As a rule, they are removed surgically.

Tumor diagnosis

To establish that the tumor is indeed an osteoma, the following procedures are performed:

• X-ray;
• CT scan;
• Magnetic resonance imaging;
• rhinoscopy of the nose;
• histological examination of part of the tumor tissue.

During diagnosis, the doctor must determine:

• degree of functionality of the affected limb or tissue;
• pain of the tumor when pressed;
• the growth rate of the tumor by the ratio of its size and the duration of the presence of pathology in the patient;
• location of osteoma.

The main method of diagnosis is radiography

. On the image it will look like a homogeneous round tumor with clear boundaries. Osteoid osteoma in the image is a vague defect - a focus of destruction.

• Radiography allows you to find out: the location of the osteoma in the bone, the structure of the tumor, the degree of destruction of the bone on which the tumor is located, and also determine whether the tumor is a single tumor or multiple growths.
• The benign nature of the tumor is confirmed by slow growth, regular structure and geometry, clear contour, and minimal calcification.
• A blood test is also prescribed because the blood formula is of great importance.
• For very small osteomas, radiography is not informative, so computed tomography is performed, which allows one to visualize the smallest details of the tumor structure and measure the size of destruction.
• Differential diagnostics with chronic Brody's abscess, osteochondrosis dissecans, osteoperiostitis, sclerosing osteomyelitis, and osteogenic sarcoma are mandatory. This applies to osteoid osteomas.

Pathogenesis

A pathoanatomical study clearly identifies the boundary of osteoid osteoma against the background of surrounding sclerotic bone tissue containing a large number of vessels. The center of the tumor (osteoid part) consists of interwoven trabeculae/strands of osteoid, which are surrounded by clusters of loose vascularized fibrous stroma and large osteoblasts located along the developing bone beams in the form of a rim. There are mitotic figures. The general appearance of the osteoid is similar to an intricate script. Less common in tumors are single/group osteoclasts.

In relatively “young” tumors, it is the osteoid that makes up the main part of the neoplasm, but as the tumor “aging”, areas of calcification appear, and in fully mature tumors, in addition to osteoids, fibrous bone, which consists of compact trabeculae, is also detected. Cartilaginous tissue is also found in tumors growing under the articular cartilage. This is the structure of the central zone of osteoid osteoma, and around it there is fibrous tissue in the form of a strip of 1-2 mm, which is rich in vessels and the trabecular pattern in it is no longer defined. Further outward there is another layer of sclerotic cortical plate.

Treatment of osteomas

If the tumor does not cause any discomfort to the patient, then medical specialists recommend observational tactics. If a small osteoma stops growing, it does not need to be treated or removed.

Osteoma is treated only surgically. Indications for removal are as follows:

1. too big size;
2. pain caused by osteoma;
3. cosmetic defect.

Removal is carried out if the osteoma compresses neighboring organs, causing pain and discomfort, is an aesthetic defect, changes the shape of bones, causes scoliosis, limits a person’s mobility, and provokes pain. Most often, specialists remove tumors in the sinuses, jaws, ear canals, hip and knee joints.

Preparation for the operation is standard. These include blood and urine tests, ECG, fluorography, consultations with a therapist and anesthesiologist. The intervention is carried out under general anesthesia; you need to spend from 1 to 3 days in the hospital, depending on the extent of the operation performed.

The SM-Clinic employs some of the best maxillofacial surgeons and neurosurgeons who perform minimally traumatic operations using modern techniques and instruments.

During the operation, soft tissues are dissected; access can be external or internal - through the mucous membranes of the mouth and nose. The tumor and part of the soft and bone tissue surrounding it are removed to avoid recurrence.

Basic removal methods:

• curettage – external access, tumor removal, curettage of the tumor focus;
• complete removal – indicated for osteomas in the sphenoid sinus;
• endoscopic removal - is carried out for small tumors and difficulties in accessing them, CT is necessarily used to monitor the progress of the intervention, the duration of the operation is about two hours.

If the removal was not completed completely, then in 10% of cases a relapse occurs. Therefore, it is important to contact a reliable clinic and an experienced surgeon.

Another method for removing osteomas is laser evaporation. A laser beam is directed at the tumor, which actually burns it out. Typically this technique is used for small tumors.

List of sources

• Burdygip I.N. Osteoid osteoma and osteoblastoma of the spine (clinic, diagnosis and surgical treatment): Dis. Ph.D. honey. Sci. M., 1993.- 182 p.
• Zatsepin S.T. Bone pathology of adults. - M.: Medicine, 2001. 639 p.
• Kolesov, V. S. Benign tumors of the face, jaws and oral cavity organs / V. S. Kolesov, A. M. Solntsev. Kyiv: Kyiv University Publishing House. 1985. 168 p.
• Karpenko A.K., Magonov E.P. The role of MRI in the diagnosis of osteoid osteoma / “RADIATORY DIAGNOSTICS” No. 3, 2014. p. 50-52.
• Epidemiology of skeletal tumors: educational manual / Chernyakova Yu.M., Ivanov S.A., Yadchenko V.N. — 2012.

Prevention

There are no special preventive measures to prevent the occurrence of osteoma. Doctors recommend taking an x-ray every year to detect the tumor in a timely manner and, if necessary, remove it.

Specialists of the medical surgical department successfully perform operations to remove various types of osteomas. If you notice a lump on any bone, contact a specialist who will make a diagnosis and promptly prescribe treatment.

There is no special prevention for this disease. The main cause of osteomas is considered to be genetic predisposition.

Some recommendations:

• avoid injury;
• timely cure diseases of the musculoskeletal system;
• undergo examination if any neoplasms of unknown origin are detected.

Popular questions

Can osteoma lead to cancer?
No. Osteoma is a benign tumor. It can cause adverse health effects if it grows into the cranial cavity. But the probability of degeneration into cancer is close to zero.

What causes osteoma?

The causes of the tumor are unknown. The role of hereditary predisposition has been established. If your relatives have been diagnosed with osteoma, you are more likely to develop it than the average population. The trigger for the growth of osteoma can be a bone injury or an acute inflammatory process. There is also a theory of intrauterine developmental defects. The reason for its occurrence was the fact that osteoma most often develops at the junction of the frontal and ethmoid bones, where membrane and cartilaginous tissues develop during embryogenesis.

Is it necessary to remove the osteoma?

The tumor grows very slowly. In most cases it is not dangerous. Only clinically significant osteomas that can grow into the orbit or skull bones are removed. The operation can also be performed for aesthetic reasons.

Sources:

1. Kudaibergenova S.F. Osteoma of the nasal cavity / S.F. Kudaibergenova [and others] // Bulletin of KAZNMU. - 2012. - No. 2. - P. 92-93.
2. Toropova I.A. Features of the clinical course of osteoma of the nose and paranasal sinuses / I.A. Toropova // Bulletin of RUDN University. — Medicine Series. - 2005. - No. 1(29). — P. 95-97.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

How to make an appointment with a traumatologist

JSC "Medicine" (clinic of academician Roitberg) in Moscow offers the services of qualified specialists in the field of diagnosis and treatment of osteoma. If you suspect osteoma, you can make an appointment with a traumatologist in various ways:

• select a doctor in the “Our Doctors” section and make an appointment online;
• call +7 (495) 775-73-60;
• leave a request for a call in a special form on the website.

The clinic is located in the central district of Moscow at 6 2nd Tverskoy-Yamskaya lane 10 (Tverskaya, Chekhovskaya, Mayakovskaya, Belorusskaya, Novoslobodskaya metro stations).