Giant Paranasal Sinus Osteoma Endonasal Endoscopic Approach with Intranasal Drill Assistance

Paranasal sinus osteomas are benign, slow-growing osteogenic tumors that are often detected incidentally but may cause significant symptoms when they reach large sizes. We report the case of a 53-year-old female patient who presented with progressive nasal obstruction and episodes of apnea during sleep for over one year. Anterior rhinoscopy revealed a rigid, immobile mass filling the right nasal cavity and deviation of the nasal septum to the left. Radiological evaluation demonstrated a large, well-circumscribed, lobulated mass with a mineralized internal structure and calcified wall measuring 52 × 26 × 48 mm, extending into the right frontal sinus, expanding the maxillary sinus ostium, and abutting the medial orbital wall. Based on clinical and radiological findings, a diagnosis of paranasal sinus osteoma accompanied by chronic sinusitis was established. The patient was successfully treated via an endoscopic endonasal approach using 0-degree and 30-degree endoscopes, with volume reduction achieved using an intranasal drill followed by complete excision. Postoperative recovery was uneventful, and no complications were observed. This case highlights that giant paranasal sinus osteomas can be safely and effectively managed using an endoscopic endonasal approach, even in cases with extensive local extension, emphasizing the importance of careful preoperative imaging and surgical planning.