A large atypical osteoma of the maxillary sinus: a report of a case and management challenges.

An osteoma within the paranasal sinuses is a rare benign fibro-osseous tumour. Osteomas occurring in the maxillary sinus are exceedingly rare and account for only 5% of the cases. A case of a 38-year-old female with an osteoma of the maxillary sinus is presented and the disease and its management are discussed. A 2 cm spherical lesion in her right maxillary sinus was picked up incidentally on a magnetic resonance imaging scan whilst being investigated for unrelated neurological symptoms and in the absence of any sinonasal symptoms. An endoscopic biopsy demonstrated that the mass was an osteoma. The management of paranasal sinus osteomas is surgical and is governed by patient symptoms, tumour size and location, in the light of the risk of future intracranial or intraorbital complications. The choice of surgical approach is determined by the location of the tumour and, the experience of the surgeon. In this case a combined external and endonasal approach was the most appropriate management due to the size of the tumour and the risk of intraorbital complications. The patient underwent a combined Caldwell-Luc and transnasal endoscopic resection without complication.