A case of Dr. Ainhoa García-Lliberos
In this case, which you can see in the surgery app SurgSchool, The Dr. Ainhoa Garcia-Lliberos He performed a resection of a fronto-orbital osteoma using an advanced endoscopic approach known as Eloy 2C. This procedure is performed at the General University Hospital of Valencia and completely restores drainage of the frontal sinus, leaving the patient asymptomatic after four months of evolution.
Case description and surgical approach
The patient presented with a rounded, radiodense bony mass on the floor of the frontal sinus, which extended into the orbit, completely obstructing the drainage of the frontal sinus and causing significant hyperostosis. Surgery began with an approach through the left nasal cavity, performing an unciformectomy to obtain space and anatomical references. Subsequently, a maxillary antrostomy was performed, followed by resection of the bulla and the Agger Nasi.
Posterior ethmoidectomy allowed exposure of the frontal recess and the roof of the ethmoid, where the hyperostotic bone blocking the drainage of the frontal sinus was identified. Since there was no direct access to the sinus, the Eloy 2C approach was performed, starting the drilling in the anterior area of the frontal sinus and advancing towards the recess.
Eloy 2C Approach Procedure
The Eloy 2C is characterized by being a technique that combines a bilateral approach to the frontal sinus with an upper septectomy to facilitate instrumental handling from both nostrils. Dr. García-Lliberos began the procedure by making an arcuate incision and detaching the mucosa in the superiosteal plane, locating the criboethmoidal foramen, a fundamental anatomical reference.
After delimiting the surgical area, the root of the middle turbinate was resected and the ascending process of the maxilla was drilled to widen the lateral access. This step is essential to ensure adequate opening of the frontal sinus. During the drilling, an extremely thick and hyperostotic bone was encountered, which made the procedure particularly laborious.
Resection of osteoma
La osteoma resection The procedure was carried out with great care, using a curette and a frontal palpator to achieve its extraction en bloc. During the process, the discharge of mucopurulent content was observed, which explained the patient's previous discomfort. In addition, the prolapsed orbital fatty tissue was released and repositioned within the periorbita.
The final drilling allowed the frontal sinus to be enlarged and the obstructive hyperostotic tissue to be completely removed. The intervention concluded with the application of an ointment containing corticosteroid and antibiotics, spongostan and surgicel to promote healing.
Postoperative evolution
Four months after the intervention, the patient is completely asymptomatic. Endoscopic examination shows proper mucosal healing, a patent frontal sinus and a fully consolidated papyracea with no evidence of residual fatty content.
The Eloy 2C approach has proven to be an effective and safe technique in complex cases such as this, allowing complete resection of the osteoma and functional restoration of the frontal sinus.
