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Year : 2020  |  Volume : 58  |  Issue : 3  |  Page : 192-193

Osteoma of maxillary sinus: A rare cause of epiphora

Department of Ophthalmology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Submission04-May-2020
Date of Decision12-Jun-2020
Date of Acceptance04-Aug-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
P Anuradha
AH 155, 3rd Street, Annanagar, Chennai - 600 040, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjosr.tjosr_50_20

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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

How to cite this URL:
Deepa R, Anuradha P. Osteoma of maxillary sinus: A rare cause of epiphora. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Oct 26];58:192-3. Available from: https://www.tnoajosr.com/text.asp?2020/58/3/192/294995

  Introduction Top

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.[1],[2] They usually remain asymptomatic and they tend to be an incidental finding on radiographic studies at their early stages.[3],[4] 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.[5],[6],[7]

  Case Report Top

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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Figure 2: Surgical excision of the bony mass

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  Discussion Top

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.[6],[7],[8] 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.[6],[7],[8],[9],[10],[11] 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.[12],[13],[14] Recurrence is common with incomplete removal of the tumor when performed especially on tumors of large size.[14]

  Conclusion Top

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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Mehta BS, Grewal GS. Osteoma of the paranasal sinuses along with a case report of an orbito-ethmoidal osteoma. J Laryngol Otol 1963;77:601-10.  Back to cited text no. 1
Eller R, Sillers M. Common fibro-osseous lesions of the paranasal sinuses. Otolaryngol Clin North Am 2006;39:585-600, x.  Back to cited text no. 2
Firat D, Sirin Y, Bilgic B, Ozyuvaci H. Large central osteoma of the maxillary antrum. Dentomaxillofac Radiol 2005;34:322-5.  Back to cited text no. 3
Lin CJ, Lin YS, Kang BH. Middle turbinate osteoma presenting with ipsilateral facial pain, epiphora, and nasal obstruction. Otolaryngol Head Neck Surg 2003;128:282-3.  Back to cited text no. 4
Moretti A, Croce A, Leone O, D'Agostino L. Osteoma of maxillary sinus: Case report. Acta Otorhinolaryngol Ital 2004;24:219-22.  Back to cited text no. 5
Sayan NB, Uçok C, Karasu HA, Günhan O. Peripheral osteoma of the oral and maxillofacial region: A study of 35 new cases. J Oral Maxillofac Surg 2002;60:1299-301.  Back to cited text no. 6
Saratziotis A, Emanuelli E. Osteoma of the medial wall of the maxillary sinus: A primary cause of nasolacrimal duct obstruction and review of the literature. Case Rep Otolaryngol 2014;2014:348459.  Back to cited text no. 7
Varboncoeur AP, Vanbelois HJ, Bowen LL. Osteoma of the maxillary sinus. J Oral Maxillofac Surg 1990;48:882-3.  Back to cited text no. 8
Park W, Kim HS. Osteoma of maxillary sinus: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e26-7.  Back to cited text no. 9
Sugiyama M, Suei Y, Takata T, Simos C. Radiopaque mass at the mandibular ramus. J Oral Maxillofac Surg 2001;59:1211-4.  Back to cited text no. 10
Kandogan T, Cetiner B, Cerci B. Ethmoidal sinus osteoma compressing the nasolacrimal duct. KBB Forum 2005;4:1.  Back to cited text no. 11
Zouloumis L, Lazaridis N, Maria P, Epivatianos A. Osteoma of the ethmoidal sinus: A rare case of recurrence. Br J Oral Maxillofac Surg 2005;43:520-2.  Back to cited text no. 12
Sternberg I, Levine MR. Ethmoidal sinus osteoma – A primary cause of nasolacrimal obstruction and dacryocystorhinostomy failure. Ophthalmic Surg 1984;15:295-7.  Back to cited text no. 13
Namdar I, Edelstein DR, Huo J, Lazar A, Kimmelman CP, Soletic R. Management of osteomas of the paranasal sinuses. Am J Rhinol 1998;12:393-8.  Back to cited text no. 14


  [Figure 1], [Figure 2]


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