What is a Paranasal Sinus Osteoma?

Paranasal sinuses are air-filled cavities located within the bones of the skull. A paranasal sinus osteoma is a benign (non-cancerous), typically slow-growing bone tumor that develops from the bony walls of these sinus cavities. It is most commonly found in the frontal sinus (forehead bone), followed by the ethmoid sinus (area between the nose and eyes). It may also rarely occur in the maxillary or sphenoid sinuses. These types of osteomas often do not cause symptoms and are usually discovered incidentally during imaging performed for other reasons.

What Causes Osteomas?

The exact cause of paranasal sinus osteomas is unknown. However, developmental anomalies, trauma to the sinus area, chronic infections, and genetic predisposition are considered potential contributing factors.

What Are the Symptoms?

Osteomas are usually asymptomatic, meaning they do not show symptoms. However, when they grow, they may cause:

• Nasal congestion
• Pain in the forehead or around the eyes
• Visual disturbances
• Facial deformity
• Frequent sinus infections

How is it Diagnosed?

The most effective method for diagnosis is Computed Tomography (CT). On CT scans, an osteoma appears as a dense bone lesion that partially or completely fills the sinus cavity. In certain cases, Magnetic Resonance Imaging (MRI) may also be used.

Is Treatment Necessary?

Not all sinus osteomas require treatment. Small and asymptomatic osteomas can be monitored. However, if there are issues like breathing difficulty, vision problems, cosmetic concerns, or recurrent sinusitis, surgical intervention is recommended.

Surgical Treatment Methods

• Endoscopic Surgery: A minimally invasive technique performed through the nose, preferred for small to medium-sized osteomas.
• Open Surgery: Performed with incisions from the forehead area in cases involving large osteomas near critical areas such as the eye socket or brain membrane.

Surgical Techniques for Paranasal Sinus Osteomas

The surgical technique used to treat paranasal sinus osteomas is selected based on the affected sinus, tumor size, symptoms, and proximity to neighboring structures. Commonly used techniques are detailed below:

Endoscopic Sinus Surgery (Endonasal Approach)

This is the most frequently preferred method, especially for medium-sized osteomas located in the frontal, ethmoid, and maxillary sinuses.

Features:

• Performed through the nose without skin incisions.
• Uses an endoscope and special microsurgical instruments.
• Provides magnified imaging via camera guidance.
• Minimally invasive: minimal tissue damage, faster recovery.

Advantages:

• No cosmetic concerns (leaves no external scars).
• Shorter hospital stay.
• Lower risk of bleeding and complications.
• High postoperative comfort.

Limitations:

• May be insufficient for very large osteomas.
• Must be performed with caution if the osteoma is near the eye or brain tissue.

Open Surgical Approaches (External Methods)

Preferred when the osteoma cannot be completely removed via endoscopic methods. Suitable for large, complex, or extracavitary lesions.

Osteoplastic Flap Approach (Frontal Osteotomy)

• Generally used for large osteomas in the frontal sinus.
• Accessed through an incision in the forehead to open the sinus.
• The sinus wall is lifted to remove the osteoma.

Lateral Rhinotomy

• Performed through an incision on the lateral nasal wall.
• Suitable for large osteomas in the ethmoid or maxillary sinuses.

Bicoronal Approach (Craniofacial Surgery)

• Used for advanced-stage osteomas close to critical anatomical areas like the eyes and brain.
• Accessed through scalp incisions, usually hidden in the hairline.
• Performed in collaboration with neurosurgery in complex, multidisciplinary cases.

Navigation-Guided Surgery (Image-Guided Surgery)

Nowadays, many centers use surgical navigation systems, especially in sinus surgeries involving complex anatomy.

• Navigation devices integrated with CT imaging allow surgeons to monitor real-time distances to anatomical structures during surgery.
• Increases safety when operating near sensitive areas such as the eyes, optic nerves, or brain.

Postoperative Follow-Up

The healing process after surgery varies depending on the size and location of the osteoma. Regular follow-up is important, and recurrence risk is low.

Frequently Asked Questions

• Is an osteoma cancer? No, it is benign.
• Is the surgery difficult? Endoscopic procedures are usually short and safe.
• Can it recur? It is rare, but possible—hence the need for follow-up.

Conclusion

Paranasal sinus osteomas are mostly silent, benign tumors. However, when they grow or cause symptoms, early diagnosis and proper treatment can lead to successful outcomes.