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      Endoscopic ultrasonic curette-assisted removal of frontal osteomas Translated title: Curette per l'osso ad ultrasuoni per la rimozione degli osteomi del frontale

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          SUMMARY

          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.

          RIASSUNTO

          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.

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          Most cited references21

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          The role of endonasal surgery in the management of frontoethmoidal osteomas.

          Recently endonasal surgery has been considered to be a valuable contribution in the management of paranasal sinus osteoma. A retrospective evaluation study of 34 frontoethmoidal osteomas (23 frontal and 11 ethmoidal osteomas) treated at a tertiary care facility from 1990 to 1999 is presented. Twenty three osteomas (68%) were resected endonasally. Eleven osteomas (32%) were removed using an osteoplastic frontal sinus approach with coronal incision. In 5 cases of huge osteomas originating at the anterior frontal sinus wall, reconstruction of the resected anterior-frontal sinus wall was achieved by autologous outer table grafts harvested from the parietal region. Endoscopic and radiological follow-up ranging from 1 to 32 months showed three incomplete endonasal osteoma resections. Complete osteoma removal was achieved via endonasal revision surgery in two of these cases, while the third small residual osteoma remains under observation. There was no case of osteoplastic osteoma removal where incomplete osteoma resection became obvious during follow-up. Ethmoidal osteomas without extrasinusal extension can be resected endonasally. The endonasal approach should be considered also for frontal sinus osteomas if (1) sufficient frontal sinus access can be achieved endonasally, (2) the osteoma is placed medially to a virtual sagittal plane through the lamina papyracea, and (3) the tumour base is at the inferior part of the posterior frontal sinus wall. We favour the osteoplastic frontal sinus approach with coronal incision if an external approach is required to achieve tumour resection with the best aesthetic results.
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            Osteoma of the skull base and sinuses.

            Osteomata of the frontal and ethmoid sinuses have traditionally been surgically removed via external approaches. However, endoscopic techniques have increasingly been used for the surgical management of selected cases. Advances in visualization and instrumentation, as well as the excellent access provided by the Draf type 3 procedure, expanded the reach of endoscopes. We describe current limits of endoscopic approaches in the removal of osteomata from the frontal sinus and our algorithms for their management. We believe that the vast majority of frontal sinus osteomata can be managed endoscopically, and that only significant anterior or extreme infero-lateral extension constitute major limiting factors.
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              Osteomas of the maxillofacial district: endoscopic surgery versus open surgery.

              Maxillofacial district osteomas are benign lesions with very slow growth. The most frequent localization is the frontal sinus, about 57% of all paranasal cavity osteomas; less frequently, they can be located in the ethmoidal sinus or sphenoidal and maxillary. Etiology has not completely clarified yet; nevertheless, there are 3 main pathogenetic theories: osteogenic, traumatic, and infective. Open procedures represent the gold standard, but there is still an unsolved debate for the best treatment option. Endoscopic techniques offer an alternative approach, enabling closer and more direct visualization of the anatomy as well as avoiding damage to surrounding structures. In our study, we analyzed all patients treated with endoscopic approach for paranasal sinus osteomas in the ENT unit of the University of Varese and compared them with patients treated for the same pathology with open surgery in the Maxillo-facial Department of the University of Rome "La Sapienza." The purpose of the work was to compare the advantages and disadvantages of the 2 procedures. In conclusion, this study underlines the importance of flexibility in surgical approach decision, which must fit the different issues of the pathology and of the patient.
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                Author and article information

                Journal
                Acta Otorhinolaryngol Ital
                Acta Otorhinolaryngol Ital
                Pacini
                Acta Otorhinolaryngologica Italica
                Pacini Editore SpA
                0392-100X
                1827-675X
                June 2014
                : 34
                : 3
                : 205-208
                Affiliations
                Department of Otorhinolaryngology, University of Brescia, Italy
                Author notes
                Address for correspondence: Andrea Bolzoni Villaret, Department of Otorhinolaryngology, University of Brescia, Italy. Tel. +39 030 3995319. E-mail: dr.bolton@ 123456libero.it
                Article
                Pacini
                4035839
                318379e6-aa7b-4802-b335-d00d58a31ba8
                © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/

                History
                : 14 January 2013
                : 27 June 2013
                Categories
                Rhinology

                Otolaryngology
                frontal sinus,sinunasal osteomas,ultrasonic curette
                Otolaryngology
                frontal sinus, sinunasal osteomas, ultrasonic curette

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