Benign bony lesions of paranasal sinuses and skull base: from osteoma to fibrous dysplasia.

IF 1.9 4区 医学 Q2 OTORHINOLARYNGOLOGY Current Opinion in Otolaryngology & Head and Neck Surgery Pub Date : 2024-04-01 Epub Date: 2023-12-13 DOI:10.1097/MOO.0000000000000955
Georgia Evangelia Papargyriou, Amanda Oostra, Christos Georgalas
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Abstract

Purpose of review: Benign bony lesions of the craniofacial complex are relatively common. However, their location close to critical neurovascular structures may render their treatment, if required, highly challenging.This article reviews the current literature on their pathophysiology, diagnosis, natural course and treatment, with a focus on most recent findings.

Recent findings: A new classification has been suggested concerning endoscopic resectability. The ratio of lateral frontal to interorbital distance can accurately and reliably predict the endoscopic reach to lateral frontal sinus, while orbital transposition can assist us in reaching lateral frontal sinus when anatomy is unfavorable. New and combined endoscopic transnasal and transorbital approaches are now in the surgical armamentarium. Prophylactic optic nerve decompression in fibrous dysplasia is absolutely contraindicated as it leads to worse visual outcomes. Radiotherapy of such lesions is of no benefit and may lead to a higher risk of malignant transformation. The presence of Guanine Nucleotide binding protein Alpha Stimulating (GNAS) mutation in chromosome 20 is universally present in fibrous dysplasia and can differentiate them from ossifying fibromas.

Summary: Diagnosis and therapeutic management of benign craniofacial bone lesions remains challenging. If surgical treatment is contemplated, the morbidity of the intervention should always be weighed against the potential benefits. Evolution of extended endoscopic endonasal and transorbital surgery means that more lesions can be reached purely endoscopically with better oncological and cosmetic results.

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鼻旁窦和颅底的良性骨质病变:从骨瘤到纤维发育不良。
审查目的:颅颌面复合体的良性骨质病变相对常见。本文回顾了有关其病理生理学、诊断、自然病程和治疗的现有文献,并重点介绍了最新发现:最新研究结果:关于内镜下可切除性,有一种新的分类方法。外侧额窦与眶间距离的比值可以准确可靠地预测内窥镜到达外侧额窦的范围,而眶转位术可以在解剖结构不利的情况下帮助我们到达外侧额窦。现在,新的内窥镜经鼻和经眶联合方法已成为外科手术的主要手段。纤维发育不良的预防性视神经减压术是绝对禁忌症,因为它会导致视力下降。对这类病变进行放射治疗没有任何益处,而且可能导致恶性转化的风险更高。20号染色体中的鸟嘌呤核苷酸结合蛋白α刺激(GNAS)突变普遍存在于纤维发育不良中,可将其与骨化性纤维瘤区分开来。如果考虑进行手术治疗,则应始终权衡介入治疗的发病率和潜在益处。扩展内窥镜鼻内镜手术和经眶手术的发展意味着更多的病变可以通过纯内窥镜进行治疗,并获得更好的肿瘤学和美容效果。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
96
审稿时长
6-12 weeks
期刊介绍: Current Opinion in Otolaryngology & Head and Neck Surgery is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With eleven disciplines published across the year – including maxillofacial surgery, head and neck oncology and speech therapy and rehabilitation – every issue also contains annotated references detailing the merits of the most important papers.
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