Osteomas are rarely benign and slow-growing osteogenic tumors, mainly involving frontal and ethmoid sinuses.

The primary objective of our study is to present the management of cases of giant frontal sinus osteomas. Secondarily, we describe our modified unilateral osteoplastic flap approach without obliteration to remove these osteomas.

Retrospective chart review at a tertiary academic center. Demographics characteristics, tumor characteristics, presenting symptoms, frontal sinus surgery technique, and outcomes of giant frontal sinus osteomas were recorded. The modified unilateral osteoplastic flap approach was used for laterally placed osteomas, tumors with posterior wall involvement, orbital roof involvement, or intracranial extension. A decision-making algorithm is proposed for the choice of surgical approach.

Ten giant frontal osteomas were analyzed. The mean age at diagnosis was 38 years old. The most common presenting symptom was a headache. 

The study concluded that osteomas are rare paranasal sinus tumors. Due to the proximity to noble structures, a giant frontal osteoma should be managed surgically. The modified unilateral osteoplastic flap without obliteration offers good long-term surgical and aesthetic results. Osteomas are not known for malignant transformation, and recurrences are rare; thus, subtotal resection is warranted and safe when a cleavage plane is not found.

Reference: https://journals.sagepub.com/doi/full/10.1177/1945892418804911