Frontal sinus and recess osteomas: an endonasal endoscopic approach

Over the last decade, there has been an increase in the use of the endonasal endoscopic approach for removing frontal sinus and frontal recess osteomas. This study aimed to describe an endoscopic endonasal treatment of osteomas without the need for an external approach.

We performed a retrospective analysis of patients that had received operations over a 5-year period in a single center.

Twenty-nine patients underwent endoscopic osteoma resections. The osteomas were graded according to the Chiu and Kennedy grading system: 12 had type I, 2 had type II, 13 had type III, and 2 had type IV osteomas. The most common indication for surgery was frontal pain. Removal of the osteoma was incomplete in three patients. Of these, one underwent successful transnasal reoperation, and the other two had tumors that extended near the mid-orbital line and were attached to the orbital roof. Based on an 11-point scale (0--no pain, 10--maximum pain), the mean pain intensity decreased from 7.5 before surgery to 3.3 (p < 0.005) after surgery for patients that underwent surgery due to frontal pain.

We found that exclusively transnasal endoscopic resections of frontal sinus osteomas were safe. However, this approach can be inadequate under some conditions. An auxiliary external approach may be required when the frontal ostium is narrow and/or when tumors are extensively attached to the orbital roof, and grow close to the midorbital point.