Management of Frontal Sinus Osteomas with Osteoplastic Frontal Sinusectomy: Report of Two Cases

Objective: Osteoma is one of most common benign tumors of the nose and paranasal sinuses, with the frontal sinus being its most frequent location. It is usually asymptomatic, although it can be locally destructive and expanding causing headache, diplopia, visual loss, proptosis, development of mucocele, and cosmetic problems. In symptomatic cases, surgical removal is the treatment of choice. The endonasal endoscopic resection, the external frontoethmoidal approach, the craniofacial approach, and the osteoplastic frontal sinusectomy have all been used to remove frontal sinus osteomas. The objective of this study is to present our experience in resection of frontal sinus osteomas using the osteoplastic flap method, and to discuss the relevant literature.

Patients: Two patients were surgically managed by our team during the years 2010–2011. The first patient was a 40-year-old man with diplopia as the presenting symptom. CT scan revealed osteoma and mucocele of the right frontal sinus, together with exposed dura and displacement of the cribriform plate and crista galli. The second patient was a 45-year-old woman with frontal sinus osteoma, causing headache and cosmetic disfigurement of her forehead. Both patients underwent osteoplastic frontal sinusectomy without fat obliteration.

Results: The patients remain asymptomatic 1 year after the surgical procedure. The aesthetic result is very satisfactory.

Conclusions: The removal of frontal sinus osteomas through an osteoplastic flap approach is the recommended procedure, especially when the osteomas affect the anterior wall of the sinus or expand laterally. The obliteration of the frontal sinus with fat is not always necessary.