What is the management of ossifying fibroma of the frontal sinus?

From the Guidelines

The management of ossifying fibroma of the frontal sinus typically involves complete surgical excision, with the primary treatment approach being endoscopic sinus surgery or open craniofacial resection, depending on the size, location, and extent of the lesion. The choice of surgical approach is crucial in achieving complete removal of the tumor while preserving function and cosmesis. According to the most recent guidelines, such as those outlined in the American College of Radiology Appropriateness Criteria 1, preoperative imaging with CT and MRI is essential for surgical planning to delineate the tumor's boundaries and relationship to critical structures.

Some key considerations in the management of ossifying fibroma of the frontal sinus include:

• The size and location of the lesion, which can influence the choice of surgical approach
• The extent of the lesion, including any potential intracranial or orbital extension
• The importance of complete removal to prevent recurrence, which can occur in approximately 10-28% of cases with incomplete resection
• The need for regular follow-up with imaging studies, typically CT scans, every 6-12 months for at least 2-3 years to monitor for recurrence

It's also important to note that medical therapy has not proven effective for these lesions, and radiation therapy is generally avoided due to the benign nature of the tumor and risk of malignant transformation 1. The use of CT and MRI for preoperative imaging is often complementary, providing valuable information for surgical planning. Overall, the goal of treatment is to achieve complete tumor removal while preserving function and cosmesis, and endoscopic sinus surgery or open craniofacial resection are the primary treatment approaches for ossifying fibroma of the frontal sinus.

From the Research

Management of Ossifying Fibroma of the Frontal Sinus

• The management of ossifying fibroma of the frontal sinus typically involves surgical resection, with the goal of relieving symptoms and preventing recurrence 2, 3.
• Endoscopic techniques have become a feasible option for the management of some fibro-osseous lesions, including ossifying fibroma, in the paranasal sinuses 2, 3.
• The choice of surgical approach depends on the size, location, and extension of the lesion, as well as the patient's symptoms and overall health status 4, 2.
• Complete en bloc excision is often required to prevent recurrence, especially when the lesions are located in the maxilla and paranasal sinuses 3.
• Endoscopic surgery is currently the primary strategy for treatment, with advantages including reduced morbidity and faster recovery times compared to traditional open approaches 4, 2.

Surgical Techniques

• Transnasal endoscopic resection is a commonly used approach for the management of ossifying fibroma in the frontal sinus and other paranasal sinuses 5, 2.
• The use of endoscopic visualization and specialized instruments allows for precise dissection and removal of the lesion, minimizing damage to surrounding tissues 2, 3.
• In some cases, a transseptal transsphenoidal approach may be used to access lesions in the sphenoid sinus or other areas of the paranasal sinuses 2.

Outcomes and Complications

• The outcomes of surgical management of ossifying fibroma are generally favorable, with most patients experiencing improvement in preoperative symptoms 4, 2.
• Complications, such as cerebrospinal fluid leaks, can occur, but are relatively rare and can often be managed with prompt recognition and repair 2.
• Recurrence of the lesion is a potential complication, emphasizing the importance of complete en bloc excision and careful follow-up 3.