|Year : 2020 | Volume
| Issue : 1 | Page : 53
Bony ball in a bony wall
Nandini Bothra1, Swathi Kaliki1, Sreedhar Boyinpally Rao2, Dilip K Mishra1
1 Ocular Oncology Service, The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
2 Ophthalmic Pathology Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
|Date of Submission||09-Mar-2019|
|Date of Decision||15-Jun-2019|
|Date of Acceptance||16-Jul-2019|
|Date of Web Publication||17-Feb-2020|
Dr. Swathi Kaliki
The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad - 500 034, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bothra N, Kaliki S, Rao SB, Mishra DK. Bony ball in a bony wall. Oman J Ophthalmol 2020;13:53
A 70-year-old woman presented with left eye progressive abaxial proptosis of 2-month duration [Figure 1]a. There was no history of trauma. Best-corrected visual acuity in the right eye was 20/20 and in the left eye was 20/200. Anterior segment examination was unremarkable in both eyes. Intraocular pressure was 12 mmHg in both eyes. The patient was pseudophakic in both eyes. Fundus examination was within normal limits in the right eye, and left eye examination revealed a pale optic disc. Computed tomographic scan of the orbit was done [Figure 1]b. The lesion was excised completely [Figure 1]c and sent for histopathology [Figure 1]d.
|Figure 1: (a) Clinical photograph, (b) computed tomography scan of the orbit, (c) gross photograph of the excised lesion, (d) microphotographs|
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| Questions|| |
- Based on the clinical features and imaging, what is your diagnosis?
- What will be your surgical approach?
- Describe the histopathology.
- Clinical features of abaxial proptosis with pale optic disc and imaging features of a well-defined hyperdense lesion arising from the ethmoid bone pushing optic nerve and globe temporally are suggestive of osteoma arising from ethmoid bone of the left orbit
- Minimal manipulation surgery can be performed by transcaruncular approach. In this case, the mass was excised in toto using the transcaruncular approach with a chisel and hammer. At the end of surgery, ethmoid sinus was intact with no medial wall dehiscence, thus avoiding direct sino-orbital contact
- Histopathology (H and E stain, ×10) shows dense, compact bone with paucicellular fibrous stroma suggestive of osteoma.
Orbital osteomas are rare and represent only <0.5%–2% of all orbital tumors.
Osteomas are slow-growing, benign lesions. They affect the cortex and metaphyseal region of the bones and have limited growth potential.
Hallmark of osteomas is severe paroxysmal pain which responds to medication.
The osteomas can be sessile, pedunculated, or dumbbell shaped, with or without thin cartilaginous covering, homogenous or heterogenous.
In our case, the lesion was a sessile homogenous osteoma without any cartilaginous covering. When symptomatic, the osteomas are best managed by surgery. Surgical approach for osteoma is based on the size, location, and extension of the lesion and whether the lesion sessile, pedunculated, or dumbbell shaped. The surgical approaches vary and can be as extensive as a coronal approach to the lesion along with patching using a graft to cover the defect.,
Ethmoidal osteomas extend medially into the orbit and are in proximity to the optic nerve. Excision is needed if they cause dystopia or diminution of vision due to optic nerve compression.
In this case, we performed excision of the ethmoidal osteoma using a chisel and hammer using the transcaruncular approach with no medial wall dehiscence. Using this technique, we achieved cosmetically and functionally good outcomes.Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their 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
The study was supported by The Operation Eyesight Universal Institute for Eye Cancer (SK) and Hyderabad Eye Research Foundation (SK), Hyderabad, India.Conflicts of interest
There are no conflicts of interest.