Clinical and Endoscopic Findings

Frontal headache or facial pain, depending on tumor location, are the most frequently reported symptoms. Pain is presumably due to pressure caused by tumor expansion, to an acute or chronic sinusitis secondary to sinus ostium blockage, or to a secondary mucocele (Lieberman and Tovi 1984; Manaka et al. 1998). Nasal obstruction and mucopurulent rhinorrhea are rarely present.

Signs and symptoms of orbital or lacrymal pathway involvement (i.e., proptosis or exophthalmos, chemo-sis, diplopia, orbital pain, epiphora, decreased visual acuity, and even transient blindness) may be observed in large size lesions. Intracranial extension may be associated with complications such as CSF leak, meningitis, brain abscess, pneumocephalus, seizures, hemi-paresis, and bitemporal quadrantanopsia (Bartlett 1971; Hartwidge and Varma 1984; Huneidi and Afshar 1989; Rappaport and Attia 1994).

In most cases, endoscopic evaluation of patients with osteoma is completely negative, the tumor being located inside a paranasal sinus. Displacement of nasal structures, such as the middle turbinate or the medial maxillary wall in case of an ethmoid or maxillary osteoma, respectively, may be observed. Direct visualization of the tumor is infrequent, occurring in large osteomas occupying the nasal fossa: the lesion appears as a firm mass covered by normal or atrophic mucosa.

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