Surgical Approach to Paranasal Sinus Osteomas: Our Experience in 22 Cases

Abstract

Objective: Paranasal sinus (PNS) osteomas are rare, but the most common benign bone tumors of the paranasal region that can remain asymptomatic until reaching certain size are usually diagnosed incidentally. This study aimed to evaluate the factors that determine the surgical approach to PNS osteomas. Methods: This retrospective study included 22 patients who underwent surgery for PNS osteoma between January 2012 and December 2018. Demographic characteristics, tumor location and size, symptoms, surgical techniques, and postoperative complications were analyzed retrospectively. The relationship between the location and size of the osteoma and the surgical approach was investigated. Results: Of the 22 patients who underwent surgery for PNS osteoma, eight (36.3%) and 14 (63.7%) were women and men, respectively. The mean age of the patients was 39.1 years (range, 21–54 years). Based on their PNS location, osteomas were found in the ethmoid, frontal, maxillary, and both frontal and ethmoid sinuses in 10 patients (45.4%), eight patients (36.3%), three patients (13.6%), and one (4.5%) patient, respectively. The tumor was excised using the osteoplastic flap technique in five (22.7%) patients with frontal sinus osteomas larger than 2 cm in size. A combination of the Caldwell–Luc and transnasal endoscopic techniques was used in three (13.6%) patients with maxillary sinus osteomas. The tumor was excised using the lateral rhinotomy technique in one patient (4.5%) with a giant osteoma in the ethmoid sinus. Osteoma excision was performed using a transnasal endoscopic approach in the remaining 12 patients with ethmoid (n ¼ 9) and frontal sinus (n ¼ 3) involvement. Conclusions: Although the tendency to perform minimally invasive and less morbid transnasal endoscopic approaches in PNS osteoma surgery is increasing, open surgical techniques and combined approaches should be preferred for ethmoid and frontal sinus osteomas with potential complications and which extend beyond the PNS boundaries. PNS osteoma size and localization, surgical equipment, endoscopic sinus surgery experience, and experience in open surgical techniques are the determinants for the surgical approach in PNS osteoma surgery.