Frontal Sinus Osteoma with Orbital Infection: A Case Report and Systematic Review of Cases

Abstract

<p><strong>Background: </strong>Frontal sinus osteomas can uncommonly invade the orbit and can be complicated with orbital infection. This article reports on a case of frontal sinus osteoma with orbital abscess and is the first systematic review of such cases. <strong>Methods: </strong>A detailed electronic search was performed on PubMed, EMBASE, and CINAHL Plus. The inclusion criteria were: adult (> 18 years old), frontal sinus involvement of osteomas, orbital cellulitis complicating osteomas.<strong> Results: </strong>A 67-year-old gentleman, with known left choroidal nevus and bilateral mild nuclear sclerotic cataract, was admitted for right eye swelling and blurring of vision for 2 days. On examination of the right eye, complete mechanical ptosis was noted. Visual acuity dropped from 0.7 to 0.025. Intraocular pressure was raised to 31 mmHg. Red desaturation was noted. Extraocular movement was limited by chemosis. A radiological diagnosis of frontal sinus osteoma with subperiosteal abscess (SPA) was made, and emergency frontal osteoma excision with combined approach and drainage of right orbital SPA were performed subsequently. Upon follow up, there was mild residual upper lid swelling, and no visual symptoms were noted. Three publications describing 3 patients met inclusion criteria and were included for systematic review. In cases with orbital infection, open or combined approaches are recommended in cases of lamina papyracea and orbital roof involvement. <strong>Conclusion: </strong>Subtotal resection of frontal osteomas with skull base involvement with open or combined approach should be considered in the setting of acute infection to avoid intracranial spread of infection.<br></p>