Giant Craniofacial Osteoma: Preoperative Planning and Strategy of Surgical Excision and Reconstruction

22 years old girl presented with huge frontal sinus osteoma destroying the craniofacial bones, both orbits, nasal bone and skull base causing severe proptosis, impaired vision and recurrent peri-orbital cellulitis. Radiologic investigations included CT scan with 3 –D reconstruction, MRI brain scan, MRA and MRV, cerebral angiogram, and Endoscopic biopsy. Preoperative planning: neurosurgery, ophthalmology, ENT, Plastic Surgery, and Craniofacial surgery teams were involved in clinical evaluation and surgical planning. Reconstruction of craniofacial defect after excision of this huge tumor was the main challenge. Pre-operative 3-D skull model with and without tumor was designed and a PEEK prosthesis was made to reconstruct the huge defect that involved frontal bones, skull base, both orbits, and nasal bones. Postoperative course was smooth, uneventful with no complication. Hospital stay after surgery was short (10 days) and the outcome was excellent.

Conclusion: Careful preoperative multidisciplinary planning and surgical approach is crucial in huge craniofacial tumors; it makes surgical excision easy, minimizes postoperative complications, reduces hospital stay and achieves the best cosmetic results and outcome.

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Keywords

osteoma - paranasal sinuses - skull base - craniofacial - surgical excision - reconstruction