Orbital osteoma
Introduction
Introduction to orbital osteoma Ocular orbital tumors occur mostly at the sutures of the sinus cartilage and membranous bone junctions, and tumor growth invades the eyelids. The adolescent bone tumor grows faster in the adolescents. Most of the patients who are treated are middle-aged. Most of the osteoma in the temporal region are derived from the sinuses without causing symptoms and signs related to the eyelids. Frontal sinus osteoma is most likely to produce eyelid symptoms, but the ethmoid sinus and maxillary sinus can also affect the eyelids, and sphenoid sinus osteoma rarely produces eyelids. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: eye movement disorders
Cause
Cause of orbital osteoma
Causes:
The cause is unknown. There are three theories about the cause of osteoma: developmental, external and inflammatory.
Pathogenesis:
Some scholars believe that during the development process, a small amount of cartilage debris is free from the bone fissure to form a sacral osteoma.
Prevention
Orbital osteoma prevention
Because the cause is not very clear, there is currently no targeted preventive measures, avoiding infection, avoiding exposure to radiation and other toxic and hazardous substances, avoiding the long-term use of certain physical and chemical substances, and avoiding drug abuse. significance. It is very necessary to timely treat the tumor with obvious compression symptoms, so as not to cause further damage and cause related complications.
Complication
Orbital osteoma complications Complications, eye movement disorders
The smaller tumors are generally asymptomatic or mild, with fewer complications.
The osteoma located in the upper part of the iliac crest is easy to damage the supraorbital nerve, the trochlear, the superior oblique muscle and the like. The process of resection of giant osteoma, which is closely related to the frontal and ethmoid sinus, can cause serious complications such as cerebrospinal fluid, nasal injury, craniocerebral injury and postoperative infection.
The person who occurs in the anterior part of the iliac crest can squeeze the eyeball or the tumor is huge, which can cause eye movement limitation.
Symptom
Eyelid osteoarthritis symptoms Common symptoms Visual impairment dull pain eyeball protruding eyeball displacement optic atrophy
1. Symptoms and signs depend on the paranasal sinus or eyelids of the origin of the lesion. Some patients have a history of paranasal sinus inflammation. The eyeballs protrude and shift in a slow process, which can be accompanied by dull pain in the eyelids.
2. Frontal sinus and ethmoid sinus are the predilection sites of osteoma. A bone tumor that occurs in the frontal sinus or dome can cause the eyeball to shift and protrude downward. The osteoma that occurs in the ethmoid sinus can cause the eyeball to shift outward, the nasolacrimal duct to block, and the like. The osteoma that occurs in the maxillary sinus is less common, and when the tumor is larger, the eyeball can be displaced upward and protruded. The sphenoid sinus osteoma often invades the optic canal and causes optic atrophy and even loss of vision. Osteoma can also occur on the outer wall of the iliac crest, which is rare.
3. The site of the anterior part of the iliac crest can be in the periorbital area and the hard mass, the boundary is unclear, the bone is continuous, no tenderness, no activity. If the eyeball is obvious or the tumor is huge, the eye movement may be limited.
Examine
Examination of orbital osteoma
Pathological examination: The osteochotomy shows a smooth, sometimes multi-lobed shape. Microscopic bone tumors can be divided into 3 types (which can overlap each other): ivory (colored), mature and fibrous. The ivory osteoma mainly consists of a small amount of fibrous connective tissue and irregular trabecular bone; mature osteoma has thin trabeculae and more trabecular fibrous tissue, fibrous osteoma has fibrous tissue and osteogenesis The activity of the cell, which is very similar to ossifying fibroma, does not show the local progressive development of the latter.
X-ray inspection
Osteosarcoma occurs in the skull, facial bone and mandible. It is most common in the sinus. A few occur in the humerus. The orbital osteoma can occur on the lateral and lateral walls of the ankle. Occasionally, the sinus ostium can be seen. Intraocular sinus, which is indistinguishable from the anterior wall osteosarcoma, can also protrude into the sacral sinus. It resembles the upper wall osteoma. The dense osteoma presents a highly dense semi-circular or round-like dense shadow. There is no trabecular structure in the bone, the edge is smooth and sharp, the density of cancellous osteoma resembles a stenosis, and the trabecular structure of the trabecular bone is seen, or it is changed by ground glass. The spotted dense shadow is seen inside, and the cortical bone is surrounded by mixed osteoma. Density, the center is a cancellous bone structure, and the difference in density of smaller osteomas is indistinguishable.
2. CT scan
The sacral osteoma is often found on CT scans for other reasons. The thin-layer scan shows a high-density mass in the tibia. The density is higher than that of the same level. The dense osteoma is difficult to distinguish the cortical bone from the bone. Liang, cancellous osteoma is rarely seen alone, surrounded by cortical bone, internal trabecular structure, osteoma is generally located in the bone, larger osteoma can protrude beyond the contour of the bone, protruding into the eyeball into the iliac crest The pressure displacement is prominent, and the local soft tissue is bulged.
3.MRI
MRI is often limited in the display of bone structure. The display of osteoma is not as clear as CT. The osteoma has a low signal on both T1 and T2 weighted images. The signal is uniform or uneven. It is located in the humerus or protrudes outward. The bone signals are connected, and the compression of the extraocular muscles and the progression of the eyeballs in the sagittal and coronal positions are clearer than CT.
Diagnosis
Diagnosis and diagnosis of orbital osteoma
diagnosis
When eyelid osteoma is suspected on the basis of symptoms and signs, an auxiliary examination should be used to confirm the diagnosis. The most important examination is X-ray orbital and CT scan. When applying these techniques, it can show the round or sub-derived bone. The leaf mass has a density similar to that of bone, and the fiber type density is low, and can be very similar to bone fiber dysplasia or ossifying fibroma; the osteoma derived from the frontal sinus has a broad base. The contour of the pedicle; while the ethmoid sinus and maxillary sinus have a thin base and a pedicled or mushroom-like contour. In addition, the possibility of Gardner syndrome should be ruled out in the diagnosis. This assessment should include the family. History and appropriate gastrointestinal examinations to rule out polyposis and cancer.
Differential diagnosis
The main need for identification of osteoma is bone dysplasia and sphenoid ridge meningioma, but it is not easy to be confused because of the special shape of the osteoma. Differential diagnosis
Abnormal proliferation of bone fibers
Teenagers are prone to slow, slow progress. More involved in a number of facial bones, such as: frontal bone, sphenoid bone, tibia, tibia, ethmoid and so on. It is characterized by facial asymmetry, flat frontal bulge, eyeball displacement and protrusion, and vision loss, visual field defect and even vision loss in the optic canal.
2. Osteofibroma
Also known as adolescent ossifying fibroma. Adolescent onset, manifested as slow progressive ocular protrusion or eyeball shift. X-ray and CT findings are related to the degree of ossification. The larger the ossification range is similar to osteoma, which is characterized by a round or elliptical border with a clear ossification.
3. Sphenoid or frontal meningioma
CT scan showed hypertrophy of bone hyperplasia, increased density, burr-like or phagocytic surface on the surface of the bone, and soft tissue shadow around the lesioned bone. MRI showed that the soft tissue lesions were clear, and more along the meninges to the intracranial growth, the "brain tail" sign is a typical performance.
4. Aneurysmal bone cyst
Adolescents are prone to occur, often occurring in the frontal bone, causing the eyeball to shift. X-ray and CT scans can be found in thin and thick bony shells with clear boundaries, cavities inside, and soft tissue density in the cavity.
