Maxillofacial district osteomas are benign lesions with very slow growth. The most frequent localization is the frontal sinus, about 57% of all paranasal cavity osteomas; less frequently, they can be located in the ethmoidal sinus or sphenoidal and maxillary. Etiology has not completely clarified yet; nevertheless, there are 3 main pathogenetic theories: osteogenic, traumatic, and infective. Open procedures represent the gold standard, but there is still an unsolved debate for the best treatment option. Endoscopic techniques offer an alternative approach, enabling closer and more direct visualization of the anatomy as well as avoiding damage to surrounding structures. In our study, we analyzed all patients treated with endoscopic approach for paranasal sinus osteomas in the ENT unit of the University of Varese and compared them with patients treated for the same pathology with open surgery in the Maxillo-facial Department of the University of Rome "La Sapienza." The purpose of the work was to compare the advantages and disadvantages of the 2 procedures. In conclusion, this study underlines the importance of flexibility in surgical approach decision, which must fit the different issues of the pathology and of the patient.