Forehead osteomata can be removed by burring

Forehead osteomata can be removed by burring or osteotome chiseling. Comparing these two methods, bone burring is not an efficient method for removing osteomata. It also increases the risk of soft tissue injury or a depressed bony surface. Removal of an osteoma by a curved osteotome is, however, both effective and safe. Usually the number of ports is not a concern, and the number of ports and sites can be chosen based on the surgeon\'s preference (Figure 3). Lai et al reported a series of six forehead osteoma cases. Resection of osteoma was achieved by a single remote port with a technique in which both the endoscope and instruments were introduced simultaneously into the port. However, the operative procedures were a little tedious and the operative time was relatively lengthy (average ∼1 hour). In our series, the operative time was short (∼30 minutes), and the benefit of endoscopic aid was noteable. Furthermore, the procedure is relatively easy to perform. The technique can be learnt quickly to a high standard, in comparison with other techniques. Current guidelines recommend a single vertical scalp incision hidden by the hair for resection of forehead osteoma, except in alopecia patients, in routine clinical practice. In case the diagnosis is changed after endoscopic examination, another vertical incision can be easily added to facilitate endoscopic excision of the mobile soft tissue masses. Forehead osteoma is a benign tumor and the recurrence rate of the tumor is very low. In our series, no tumor recurrence was noted. Our series is the first to have a follow-up period of >5 years. There are very few complications of endoscope-assisted resection of forehead osteoma. Possible complications are similar to those described for the conventional forehead endoscopic procedure, mainly neurosensory damage and vascular injury. Again, the vertical incision was recommended instead of an incision parallel to the hairline because the course of the sensory buy moexipril is longitudinal in the supraperiosteal plane. The site most susceptible to injury is the scalp port; the risk might be higher if two ports or more are necessary for endoscope-assisted manipulation. Massive bleeding is not likely to occur in the rough surface of the bone, although it is considered possible. Since the osteoma is mainly a laminated bone tumor and the frontal bone is a membranous bone, bleeding is usually not a concern.
Conclusion
Case Report The patient\'s physical examination revealed a markedly diminished general condition, including fever, tachypnea, tachycardia, and hypotension. The right inguinal mass exhibited tenderness and irreduction. Although his abdomen was soft with mild tenderness over the lower quadrant, the patient showed no signs of bowel obstruction. Laboratory studies revealed a glucose level of 376 mg/dL, a white blood cell count of 33.50 × 109/L, and a neutrophil content of 97.8%. A chest X-ray showed cardiomegaly with a suggestion of congestive heart failure. A diagnosis of right incarcerated inguinal hernia was made, and an operation was scheduled. Through a right inguinal incision, the hernia sac was opened first, along with a segment of the colon, without strangulation; foul smells of turbid ascites were noted. A high ligation of the hernia sac was performed and Bassini\'s repair was undertaken. Diagnostic laparoscopy was then performed through an umbilical incision. Sigmoid diverticulitis with a perforation, approximately 5 mm × 5 mm in size, near the incarceration site (Fig. 1) and fecal peritonitis with turbid ascites (approximately 100 mL) were found. Because of the patient\'s poor oxygen saturation—tachycardia and hypotension were noted during the operation—only repair of the sigmoid perforation and drainage of the intra-abdominal abscess were performed. After the operation, the patient, on an endotracheal tube with a ventilator, was transferred to a surgical intensive care unit for further care.