A surgery by Dr. Alfonso Santamaria
In this case, the Dr. Alfonso Santamaría do the removal of a giant frontal osteoma In a 70-year-old patient, with history of nasal polyposis and aspirin-exacerbated respiratory disease (AERD). This procedure is available in our SurgSchool surgical training app.
Case Description
This patient had undergone two previous surgeries due to nasal polyposis, one in 2009 and another in 2022. The osteoma was initially detected by follow-up imaging, which showed progressive growth in the frontal sinus. During the nasal endoscopy, only polyposis was observed; however, detailed imaging revealed a large osteoma in the frontal sinus with impaction on the posterior table.
Surgical procedure
The surgery began with the identification of necessary anatomical references due to previous surgeries. To access the osteoma, a antrostomy in the right maxillary sinus, followed by a mucosal resection y milling until locating the cell of Ager Nassi, a key reference for the frontal recess.
Dr. Santamaría continued with a posterior septectomy, necessary to connect the frontal recesses and create a wider access through a technique DRAF III. When milling the frontal bone, the osteoma and its boundaries were identified. After ensuring the safety margin, the osteoma was fragmented to extract it without damaging neurovascular structures.
Extraction and Results
To avoid possible damage, the osteoma was fragmented into several parts. After removal of the central fragment, it was observed that the hardness of the bone required additional milling to reduce its size and allow its extraction through the DRAF 3 access. During surgery, the mucosa of the sinus was preserved and the dura mater remained intact.
This case highlights the success of the intervention to remove a significant mass without subsequent complications, providing effective relief to the patient and maintaining safety in the approach to complex frontal osteomas.
