Giant fronto-ethmoidal osteoma - selection of an optimal surgical procedure

Introduction: Osteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator. Objective: Determine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature. Methods: Group of 37 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied. Results: The authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p = 0.2691) and the frontal sinuses (p = 0.5891). Conclusion: The choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques. (C) 2017 Associacao Brasileira de Otorrinotaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.