Fontal Sinus Osteoma: A Huge Craniofacial Tumor Preoperative Planning and Strategy of Surgical Excision and Reconstruction

Osteomas are the most common fibro-osseous lesions in the paranasal sinus. They are benign tumors characterized by slow growth and are often asymptomatic. Treatment is indicated in sphenoid osteomas that threaten the optic canal or orbital apex and in symptomatic cases. We report a case of a giant frontal sinus osteoma with orbital invasion treated by a combined open craniofacial approach with reconstruction of the anterior cranial base and orbital walls. Immediate reconstruction allows aesthetic and functional restoration of neighboring structures, which should one of the goals in the treatment of this benign entity. The literature is reviewed and aetiopathogenic theories, diagnostic procedures and surgical approaches are discussed. The choice of surgical management depends on the location, size and experience of the surgeon. An open approach allows tumor removal with direct visual control and remains the best option in large tumors, but the continued progression in endoscopic approaches is responsible for new indications in closed techniques.