Osteoma is a benign osteogenic lesion with a very slow growth, characterized by proliferation of either cancellous or compact bone. Depending on its location, osteoma may be classified as central, peripheral, or extraskeletal type. Osteoma has been reported in relation to the paranasal sinuses and less frequently with the orbit. We report a case of a 25-year-old female who developed extraskeletal osteoma on her left upper eyelid, without involvement of the paranasal sinuses or orbit. Extraskeletal osteoma of the eyelid is an extremely rare variety. The mass was surgically removed and sent for histopathologic examination, which showed osteoma. To the best of our knowledge, this is the first case of extraskeletal osteoma of the eyelid reported in the English language literature.
Extraskeletal osteoma, lid osteoma, Sudhir Singh
Sudhir Singh, MS, has no conflicts of interest to declare. No funding was received for the publication of this article.
August 02, 2015 Accepted
August 17, 2015
Sudhir Singh, MS, Senior Consultant & HOD, Department of Ophthalmology, JW Global Hospital & Research Centre, Mount Abu, Rajasthan, India 307501.
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Compliance with Ethical Guidance: Informed consent was received from the patient involved in this study.
A healthy 25-year-old female patient, with a 6-month history, reported with a chief complaint of left upper lid mass and droopiness. History revealed that the swelling initially started as a peanut size and had gradually increased to the present size. Ocular examination was suggestive of nontender, bony hard, noncompressible, nonfluctuant, and nonpulsatile swelling on the left upper lid (see Figure 1A and B). The superior, inferior, medial, and lateral margins were well palpable. Mass was nonadherent to orbit, and it could be digitally displaced horizontally or vertically (see Figures 1C and D). The size of the swelling was 25 × 15 × 10 mm.
There was a history of blunt trauma to the left upper lid, and 3 months before she noticed this swelling. There was no history of vision changes, ocular pain, pain with eye movement, or headaches. Her vision was 20/20 in both the eyes. Both the eyes underwent slit lamp examination and fundus was also normal.
Past ocular history and medical history were noncontributory.
Review of systems was negative.
The patient was operated under local anesthesia. Two silk sutures were taken near the lid margin to provide traction during surgery. The globe was secured with an entropion plate. Lid crease incision was performed superficial to tumor (see Figures 2A and B). The lesion was isolated from the surrounding tissue by blunt dissection. Dissection was easily carried out around the mass except for the lower portion, which was found adherent with tarsal plate (see Figures 2B–D). The tumor and its extent were identified. The lesion was excised completely (see Figure 2E). No communication with the orbit or sinuses could be identified.
The tarsal plate was sutured with 6-0 vicryl interrupted sutures. Skin was sutured with interrupted 6-0 vicryl sutures (see Figure 2F). Patient’s ptosis was mostly recovered on 14th postoperative day (see Figure 3B). Specimens sent for histopathologic examination and histopathologic findings were consistent with an osteoid osteoma.
The tumor was an encapsulated nodular lesion 25 × 15 × 10 mm in size. The consistency was bony hard. The anterior surface was glistening— white to pink color and was smooth with rounded protuberance. The cross-sections of specimen could not be cut by scalpel (see Figure 4).
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Extraskeletal osteoma, lid osteoma, Sudhir Singh