Approximately 3 % of people have paranasal sinus osteomas according to Earwacker (1993). In his series of 1500 CT scans, only two patients were symptomatic. This is the authors' experience. Many osteomas are found incidentally and are blamed for causing headaches or excision is recommended before they cause symptoms (Hehar and Jones, 1997). In practice, osteomas rarely cause any problems other than cosmetic. If they do cause symptoms by obstructing the frontal recess, their history should include symptoms that are worse after upper respiratory tract infections and there should be endoscopic and CT scan signs of mucosal disease (Fig. 15.38a-c). All too often tension-
Fig. 15.38 a Osteoma obstructing the right frontal recess; note whether there is evidence of other paranasal sinus pathology, otherwise reconsider the need to operate. b Postoperative CT scan and c endoscopic view.
c type headaches are blamed on an osteoma that is coincidental.
The removal of osteomas depends on how accessible they are (Schick et al., 2001) (Fig. 15.39). The endoscope can be used to shell out the osteoma and then its walls can be removed or fractured inwards. As the most symptomatic ones are in the frontal recess, it is important to reconstruct the mucosal lining with a septal flap or a free mucosal graft or to combine their removal with a median drainage procedure.
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