Osteomas of the paranasal sinuses: surgical treatment options.

Background: Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses occurring mainly in the frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, continue to enlarge, are localized in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, regardless of size, in symptomatic tumors. Progressive headaches and chronic inflammation of the adjacent mucous membrane are the most common symptoms. Surgical approaches are divided into external, endoscopic drill-out, and combined endoscopic and external procedures.

Methods: Seventeen patients with osteomas of the paranasal sinuses were studied (mean age: 42.7 years, range: 15-73 years). Most commonly involved was the frontal sinus (11 cases, including a giant tumor comprising both frontal sinuses and 2 osteomas penetrating to the orbit), followed by ethmoid cells (3) and maxillary sinuses (2).

Results: One osteoma was diagnosed in the sphenoid sinus. All were removed surgically. Eight open procedures were performed to remove frontal and maxillary osteomas, five tumors were removed under endoscopic guidance, and four via combined procedures. No postoperative complications were observed. No recurrences were noted. All patients remain asymptomatic.

Conclusions: Resection of small and medium-sized osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects. Giant frontal sinus osteomas can be effectively approached by a combined external and endoscopic procedure. Obliteration of the sinus is not mandatory if the mucous membrane is intact.