Year : 1966 | Volume
: 14 | Issue : 3 | Page : 141--143
Osteoma of the orbit
MR Chaddah, BK Ahluwalia
Department of Ophthalmology, Medical College, Rohtak, India
M R Chaddah
Department of Ophthalmology, Medical College, Rohtak
|How to cite this article:|
Chaddah M R, Ahluwalia B K. Osteoma of the orbit.Indian J Ophthalmol 1966;14:141-143
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Chaddah M R, Ahluwalia B K. Osteoma of the orbit. Indian J Ophthalmol [serial online] 1966 [cited 2021 Jun 14 ];14:141-143
Available from: https://www.ijo.in/text.asp?1966/14/3/141/38647
Osteoma of the orbit is relatively rare. Bullock and Reeves (1959) studied 138 cases of unilateral exophthalmos radiologically and did not find any case of osteoma. Ahluwalia (1964) in his survey of 25 cases of proptosis did not report any orbital osteoma. Moss (1962) while analysing Jone's and Reese's series of 230 cases of expanding lesions of orbit, found the incidence of osteoma to be one per cent. Ingall's (1953) review of 216 cases of tumours of the orbit revealed 2 cases of osteoma seen over a period of 12 years.
We have observed only 3 cases of osteoma of orbit over a period of 15 years.
Case l: R. S.: 30-year-old male farmer, presented on August 6, 64 with protrusion of the right eye since 5 months. About one month previously he had sustained a blunt injury to the medial part of the superior orbital margin. Swelling of the lids, pain, redness and watering subsided after 20 days of injury but proptosis and deteriorated vision persisted. Systemic examination revealed nothing abnormal. On local examination, the left eyeball was found to be normal. Right eyeball was proptosed forwards and slightly downwards and outwards by 6 mm. At the supero-medial angle of the orbit, palpation revealed an ill-defined, painless, lobulated and a very hard fixed mass, about 1 cm x 1 cm extending backwards into orbit and it was firmly adherent to the bony orbit. Mobility of the globe was restricted up and in. Visual acuity was R 4/60.
L 6/12. Homatropine refraction revealed -- I D myopia R.E. but glasses did not benefit. Fundus examination revealed an oedematous and hyperemic disc with blurred margins and there was congestion of retinal veins. Blood counts and serology were non-contributory. Radiological investigation of the orbits demonstrated osteoma right side.
On Sept. 8, 64, a supero-medial orbitotomy was performed under general anaesthesia. A sessile hard, white, lobulated and well-circumscribed osteoma 3.5 cm x 3 cm x 2.5 cm [Figure 1] and weighing 22.83 gm. was removed after detaching the tendon of superior oblique which was restitched to the periosteum.
The post-operative period was uneventful with full eye movements and there was no diplopia. Diagnosis was confirmed by histopathological examination. Oedema of the disc regressed and vision improved to R.E. 6/24 but glasses were of no benefit and it eventually led to partial optic atrophy.
Case II: T. D.: aged 23, a housewife, presented on Jan. 30, 65 with prominence of left eyeball since 10 days. Preceding this, patient was aware of some heaviness of the left side of the head along with a hard and painless almond size mass in the left orbit since 21 years. There was no history of diplopia or nasal symptoms.
Pertinent ophthalmological findings were confined to the left eye. Palpebral fissure was narrow. There was an irreducible proptosis downwards and forwards by 5 mm. Movements of the globe were restricted upwards. A lobulated, painless and ivory hard mass was palpable in the entire superomedial part of the orbit; visual acuity was 6/36, Jii. Defective vision was due to three small corneal nebulae. Glasses did not effect improvement. Ophthalmoscopy was normal. General medical survey including urinalysis, blood examinations revealed nothing abnormal. Roentgenological examination showed a large osteoma of the left orbit entering into the frontal sinus [Figure 2].
On Feb. 6, 1965, a supero-medial orbitotomy was carried out under general anaesthesia. Reflected tendon of superior oblique was stitched back to the periosteum after excision of the osteoma from its base. The osteoma was extending into the frontal sinus through an erosion of its floor. There was no intracranial extension. It was a hard, glistening white, nodular tumour partly covered by mucous membrane, measuring 2.75 cm x 2.25 cm x 1.5 cm and weighing 8.62 gm. Microscopic examination confirmed the diagnosis of ostcoma. Convalescence was uneventful.
In our experience, osteoma of the orbit is a rare cause of unilateral proptosis and this observation finds support from the work of many authors (Bullock and Reeves, 1959; Ahluwalia, 1964: Moss 1962: and Ingalls, 1953).
Patient of orbital osteoma may present with ocular, cerebral or nasal symptoms depending upon site of origin of the tumour, with many remaining a symptomatic.
One of the cases showed papilloedema which was explained by raised intraorbital pressure and compression of the optic nerve. This, however, regressed after surgery leaving behind partial optic atrophy. The diagnosis of osteoma is confirmed by radiological examination and the only treatment in cases with symptoms is timely surgical excision. Commonly the tumour originates from the paranasal sinuses and invades the orbit mostly at the supero-medial angle. This was true of our cases where one sessile growth was arising from anterior ethmoidal cells and the other was from frontal sinus. The latter had eroded the outer part of the floor of the frontal sinus. Before undertaking surgery, it is imperative to carefully study the origin and size of the tumour as well as to exclude or determine the extent of the intracranial extension. None of our cases had spread to the cranial cavity. The only difficulty encountered during surgical excision is the injury and subsequent dysfunction of superior oblique muscle. This could be prevented by detaching the tendon of superior oblique from the pulley and stitching it back to the periosteum after removal of the growth.
Incidence of orbital osteoma is discussed and two such cases, one each arising from ethmoidal sinus and frontal sinus, are presented. Both tumours were removed successfully via an anterior orbitotomy without postoperative diplopia.
We wish to extend our gratefulness to Dr. G. C. Mehrotra, Professor of Pathology. Medical College. Rohtak, for his help in Histopathological study.
|1||Ahluwalia, B, K. (1964): Thesis for M.S. examination, Punjab University.|
|2||Bullock. L. J.; and Reeves, R.J.; (1959). Amer. J. Roentgenol. 82: 290-299.|
|3||Ingalls, R. G. (1953): Tumours of the orbit and allied Pseudotumours. p. 273-280. Charles C. Thomas Publishers Spring Field U.S.A.|
|4||Moss, H. MacMillan (1962): Amer. J. Ophth. 54: 761-770.|