Skeletal Radiol (1993) 22:417 423

Skeletal
Radiology

Paranasal sinus osteomas: a review of 46 cases

John Earwaker
Departments of Radiology, Holy Spirit Hospital and Princess Alexandra Hospital, Brisbane, Australia

Abstract. In a survey of 1500 coronal sinonasal CT scans, Materials and methods

46 patients were found to have paranasal sinus osteomas.
The overall incidence was 3%, with a predilection for One thousand six hundred and thirty coronal sinonasal CT scans
decades 5 and 6 and a male-to-female ratio of 1.3: 1. The were reviewed to determine the incidence and types of anatomical
variants present in the nose and sinuses [12]. Patients were referred
frontal sinus was most commonly involved, and of these
for assessment of sinonasal inflammatory disease and/or for evalu-
lesions 37% were in the immediate vicinity of the na- ation for functional endoscopic sinus surgery. The examinations
sofrontal duct and 21% above and lateral to the ostium. were performed on a GE 9800 or a GE Pace Scanner (GE Medical
Tumour size varied from a mean diameter of 1.5 m m to Systems, Milwaukee/Yokagawa). A sequence of direct coronal
30 mm; however, 17 lesions were 5 mm in size or less. scans was carried out on each patient using a bone algorithm with
Five matrix patterns were observed. Only two patients a 3-mm contiguous scan technique through the anterior half of
the paranasal sinuses and a 5-mm contiguous scan technique
were symptomatic and only three osteomas excised. Iso-
through the posterior half. As part of the protocol 4 • 5 mm contig-
tope bone scanning may be a useful screening test with uous scans were performed through the optic grooves to evaluate
specific follow-up utilising computed tomography. the relationship of the posterior ethmoid air cells to the optic
nerves. These scans included many of the anterior and posterior
Key words: Osteoma Paranasal sinus o s t e o m a - Frontal ethmoid air cells but did not encompass the full extent of the
frontal sinuses.
sinus osteoma The age range of the patients reviewed was 4-82 years, and
the distribution is depicted in Fig. 1. Of the 1500 patients, 782
were male and 718 were female.
The 1630 examinations were reviewed retrospectively and the
scans of 130 patients were excluded from the series where the sino-
The term osteoma is reserved for a well-defined, slowly nasal anatomy had been altered due to previous surgery, anterior
growing t u m o u r composed of osseous tissue generally and/or posterior ethmoidectomy.
found in the skull, paranasal sinuses and the mandible
[34]. Osteomas o f the paranasal sinuses originate in the
Results
sinus wall and grow into the lumen. They are traditional-
ly named after the sinus invaded rather than thai from
Incidence o f osteomas in relation to patient age and sex
which they originate [6].
Since the first report of removal of a tumour o f the
Osteomas were identified in the paranasal sinuses in 46
frontal sinus by Veiga in 1586, osteomas have been the
cases. The age range of patients with osteomas was 18-
subject of various case reports and literature reviews
72 years; the distribution is depicted in Fig. 2. Twenty-
[32]. Because of their slow growth, in the period prior
two were female and 24 male. Thus, the overall incidence
to and even after the discovery of X-rays they usually
of osteoma in this series was 3.0%, ranging from 2%
presented clinically as large lesions. With the advent of
in decades 2~1 to 5.7% in the seventh decade. The ad-
computed tomographic (CT) scanning, however, smaller
justed male to female ratio was 1.3: 1.
lesions are being detected by this more sensitive tech-
nique, and hence more lesions are being discovered in
essentially asymptomatic patients. Distribution o f lesions

The frontal sinus was the most commonly involved site

Correspondence to: Dr. J. Earwaker, Holy Spirit Hospital, 259 with 37 cases including one patient with three separate
Wickham Terrace, Brisbane, 4000 Australia lesions. Seven tumours affected the anterior ethmoid sin-

9 1993 International Skeletal Society

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1 2 ; 4 ; 6 7 8 2 3 4 5 7 8
Decade Decade

Fig. 1. Age range in 1500 reviewed cases Fig. 2. Age range in 46 patients with osteoma

Fig. 3. Small osteoma (8 x 8 x 5 ram) demonstrated in the coronal
plane arising near the ostium of the frontal sinus. It is sessile with
a medial attachment
Fig. 4A, B. Sessile osteoma (9 x 9 x 7 mm) demonstrated in A the
coronal plane and B the axial plane, arising from the frontal sinus
floor above and lateral to the ostium, related to the lacrimal bone
and the medial orbital wall and situated more laterally than an
ostial lesion
Fig. 5. A Normal bilateral bony intrusions related to the bases
of the nasal bones, to be differentiated from a large " o s t i a l " lesion
(B) and a lesion occurring within a right-sided frontal bulla (C)
Fig. 6. Frontal sinus osteoma arising from a laterally placed septum
Fig, 7. A Tumour with a homogeneous dense matrix arising from
and expanding on b o t h sides of a frontal sinus septum. B Normal
expansion of the septum merging with C the frontal bone in the
contiguous anterior slice
Fig. 8. Sessile osteoma with a dense homogeneous matrix arising
from the roof of the left frontal sinus
Fig. 9. Small anterior ethmoid osteoma (3 m m in diameter) accura-
tely localised on the coronal scan. It was difficult to localise on
the axial scan alone