Paranasal Osteoma: The Importance of Surveillance

Paranasal osteomas are rare benign bone tumours originating within the paranasal sinuses. Despite their benign nature, these slow-growing osseous lesions can lead to a spectrum of symptoms ranging from asymptomatic discovery to nasal obstruction, headache, facial deformity, and ophthalmological complications. We present the case of a 52-year-old female who initially presented with chronic sinusitis-like symptoms in 2008 and was incidentally found to have a small right-sided paranasal sinus osteoma on CT. Eleven years later, in 2019, she re-presented with new symptoms of unilateral nasal obstruction, epiphora, and restriction in her lateral gaze and was diagnosed with a large osteoma causing structural and ophthalmological issues (proptosis and epiphora). Endoscopic removal of the osteoma successfully alleviated her symptoms. This case emphasises the importance of surveillance of paranasal osteomas as there are no formal guidelines to support clinicians, as even though they grow slowly, they can eventually lead to significant "mass-effect" symptoms and impact local structures. Thus, monitoring and consideration of surgical intervention are crucial to managing these lesions effectively.