Title: Giant middle turbinate osteoma diagnosis and management

Abstract

Sinonasal osteomas are the commonest benign tumours of the paranasal sinuses with an approximate true incidence rate between 0.014% and 3%. We present a patient with intractable frontal headache and intranasal polyposis, who was found to have a massive, complex osteoma arising within a concha bullosa. A 23 year old male presented with severe symptoms poorly responsible to medical management with rapidly progressive, associated with diplopia and imbalance. Investigations : The scan revealed a very large osteoma (59.81 mm × 33.38 mm x 32.00 mm) arising within a right-sided concha bullosa of the middle turbinate and extending into the nasopharynx was shown in CT scan. Management : The patient underwent an urgent image-guided modified endoscopic Lothrop's procedure to facilitate complete endoscopic excision thorough sinus drainage. To date, there are only 8 case reports of osteoma of the middle turbinate. We are, presenting the case where the osteoma of an aerated middle turbinate was of such a massive size. This case highlights the importance of giving common symptoms, such as headache, the required attention and consideration before dismissing them as trivial. Conclusion: The case reported herewith represents the largest known concha bullosa osteoma. It is the first to be removed entirely endoscopically. It is also the first removed via a modified endoscopic Lothrop approach. This very challenging case highlights the importance of thorough interrogation of pre-operative clinical assessment, imaging and careful planning of the surgical procedure.