What is the treatment for a frontal sinus osteoma?

From the Guidelines

Surgical removal is the primary treatment for a frontal sinus osteoma, particularly when symptomatic or large, as it provides the best outcome in terms of morbidity, mortality, and quality of life. The approach to surgery can vary, with options including endoscopic sinus surgery for smaller, more accessible osteomas, or open approaches like osteoplastic flap procedures for larger or more complicated cases 1. Asymptomatic, small osteomas may be managed conservatively with observation through periodic imaging, rather than immediate surgery. The decision to proceed with surgery is influenced by several factors, including the presence of symptoms such as headaches, facial pain, or sinusitis, the size and growth rate of the osteoma, its location, and the potential for complications like orbital or intracranial extension.

Key considerations in the management of frontal sinus osteomas include:

• The size and symptoms of the osteoma
• The potential for growth and complications
• The availability and appropriateness of different surgical approaches
• The importance of complete removal to prevent recurrence and ensure the best possible outcome

In terms of diagnostic imaging, CT maxillofacial with or without IV contrast, or MRI orbits, face, and neck with IV contrast, can be appropriate for evaluating suspected sinonasal masses, including frontal sinus osteomas, as these modalities can provide complementary information necessary for effective management 1. However, the choice of imaging should be tailored to the individual case, considering factors such as the need for detailed bony architecture versus soft tissue evaluation.

Post-operative care for patients undergoing surgical removal of a frontal sinus osteoma typically involves measures to promote healing, prevent infection, and ensure the restoration of normal sinus function. This may include saline irrigations, short-term antibiotics in some cases, and follow-up imaging to confirm complete removal of the osteoma and assess for any potential complications. Given that frontal sinus osteomas are benign, slow-growing bony tumors, their complete surgical removal is generally associated with excellent outcomes and low recurrence rates.

From the Research

Treatment Options for Frontal Sinus Osteoma

The treatment for a frontal sinus osteoma typically involves surgical removal of the tumor. The choice of surgical approach depends on the size and location of the osteoma, as well as the presence of any complications or symptoms.

• Surgical Approaches: Various surgical approaches can be used to remove a frontal sinus osteoma, including:
  • External frontoethmoidal approach
  • Osteoplastic frontal sinusectomy
  • Endoscopic drill-out
  • Combined endoscopic and external procedures
  • Craniofacial approach
  • Modified unilateral osteoplastic flap approach without obliteration 2, 3, 4, 5
• Indications for Surgery: Surgery is typically indicated for osteomas that:
  • Extend beyond the boundaries of the frontal sinus
  • Are enlarging
  • Are localized in the region adjacent to the nasofrontal duct
  • Show signs of chronic sinusitis
  • Cause symptoms such as headache or other complications 2, 3, 6
• Outcomes and Complications: The outcomes of surgical treatment for frontal sinus osteoma are generally good, with low rates of recurrence and complications. However, complications such as local infection, sinusitis, and cosmetic deformity can occur 3, 4, 5
• Decision-Making Algorithm: A decision-making algorithm can be used to choose the best surgical approach for each individual case, taking into account the size and location of the osteoma, as well as the presence of any complications or symptoms 4