|Year : 2020 | Volume
| Issue : 3 | Page : 192-193
Osteoma of maxillary sinus: A rare cause of epiphora
R Deepa, P Anuradha
Department of Ophthalmology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
|Date of Submission||04-May-2020|
|Date of Decision||12-Jun-2020|
|Date of Acceptance||04-Aug-2020|
|Date of Web Publication||14-Sep-2020|
AH 155, 3rd Street, Annanagar, Chennai - 600 040, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Osteomas are fibro-osseous lesions of the nose and paranasal sinuses. We report a case of a 14-year-old girl who presented with complaints of left-sided epiphora along with intermittent mucoid discharge for 6 months. Based on the clinical diagnosis of left nasolacrimal duct obstruction, radiological investigations were done which reported as an osteoma of the left maxillary sinus, compressing the nasolacrimal duct. The patient underwent conventional dacryocystorhinostomy and the tumor was removed. To the best of our knowledge, acquired nasolacrimal duct obstruction due to an osteoma of maxillary sinus is a rare presentation and has been reported only in few literatures.
Keywords: Epiphora, nasolacrimal duct obstruction, osteoma of paranasal sinus
|How to cite this article:|
Deepa R, Anuradha P. Osteoma of maxillary sinus: A rare cause of epiphora. TNOA J Ophthalmic Sci Res 2020;58:192-3
| Introduction|| |
Osteomas are benign bone-forming tumors developing in the paranasal sinuses and nasal cavity.
The most common site is the frontoethmoidal region in 95% of cases, involving the frontal sinus in 60%–70% followed by ethmoidal sinus in 20%–30%, maxillary sinus accounting for only 5% and rarely found in sphenoid sinus and nasal cavity., They usually remain asymptomatic and they tend to be an incidental finding on radiographic studies at their early stages., Acquired nasolacrimal duct obstruction may be primary or secondary, of which secondary causes may be due to infection, inflammation, tumor, or trauma. Maxillary sinus osteoma is a rare entity and we report a case of an osteoma of the maxillary sinus causing nasolacrimal duct obstruction which has been reported only in few literatures.,,
| Case Report|| |
A 14-year-old girl presented with complaints of watering of left eye along with intermittent mucoid discharge for 6 months. No history of head trauma or nasal and paranasal sinuses surgeries in the past. On ocular examination, her visual acuity was 6/6 in both the eyes with normal extraocular movements. Anterior and posterior segment examination was normal. On pressure over the lacrimal sac area there was regurgitation of mucopurulent discharge from the punctum in the left eye. On lacrimal irrigation, there was regurgitation of mucopurulent fluid from the opposite punctum and hard stop on probing, thus confirming the clinical diagnosis of left side nasolacrimal duct obstruction. Ear, nose, and throat (ENT) examination revealed a deviated nasal septum in the left nasal cavity. Radiograph of the nose and paranasal sinuses showed a well-circumscribed mass in the left maxillary antrum. Based on the above findings, computed tomography scan of the paranasal sinus and orbit was done which revealed a well-defined rounded, dense bony mass arising from the left maxillary sinus, suggestive of an osteoma compressing the left nasolacrimal duct with no invasion into the orbit [Figure 1]. Subsequently, with a multidisciplinary team of an ophthalmologist, ENT, and oral and maxillofacial surgeon, the patient underwent conventional dacryocystorhinostomy and the osteoma was removed. Histopathology report of the excised mass composed of dense, compact bone and broad trabeculae of lamellar [Figure 2] bone within the paucicellular fibrous stroma with a sharply demarcated outer surface thus confirming the diagnosis of an osteoma. Following an uneventful procedure, on further follow-up, lacrimal system was patent on irrigation and the symptoms of the patient also resolved.
|Figure 1: Computed tomography (axial section) of nose, paranasal sinus and orbit, showing a radio-opaque bony mass arising from the left maxillary sinus|
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| Discussion|| |
Osteomas are fibro-osseous lesions of the paranasal sinuses and nasal cavity. They occur most frequently in young individuals, in the second and third decades of life with a male to female ratio of 2:1 According to the clinical and radiological topography, they may be classified as peripheral, central, or extraskeletal. Peripheral osteoma occur most commonly in the head and neck region The cause of an osteoma remains unclear, but evidence suggest that it could be of embryological, traumatic, or infective causes. Symptoms vary depending on the size and site of the tumor. The most common symptoms include headache, marked deformities of the face, and nasal obstruction.,, According to various reports, it has been noted that osteomas causing nasolacrimal duct obstruction with symptoms of epiphora are usually associated with the ethmoid sinus and rarely involving maxillary sinus.,,,,, Surgery is indicated which depends on the size of the tumor, possible onset of infections, worsening of symptoms, or complications due to its compression and it is usually removed in toto.,, Recurrence is common with incomplete removal of the tumor when performed especially on tumors of large size.
| Conclusion|| |
The case has been reported because of its rare presentation and osteoma of maxillary sinus should also be considered while evaluating a patient with epiphora.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]