Benign tumors of the frontal sinuses

Management of disease of the frontal recess and frontal sinus is one of the greatest challenges in rhinology. Despite advances in the understanding of the anatomy and physiology of this area along with increased comfort with endoscopic techniques, management of this area remains difficult due to its tight rigid bony anatomic constraints. As treatment of inflammatory disease of this area continues to pose a therapeutic challenge, it is of no surprise that frontal sinus tumors are particularly difficult to manage. Many of the benign tumors that occur in this area have the potential to recur and spread into adjacent structures and compartments. Anterior extension to the skin of the face can lead to significant cosmetic deformity,whereas posterior extension into the anterior cranial fossa can lead to dural erosion, brain compression, and increased intracranial pressure. Inferior growth can lead to orbital symptoms including diplopia, proptosis, and decreased visual acuity. In all cases, tumor growth may lead to postobstructive frontal sinusitis with the possibility of spread to adjacent regions including the orbit, intracranially, or subcutaneously. For the purposes of this chapter, benign frontal sinus tumors will be primarily classified into: Fibro-osseous tumors Inverted papilloma Mucoceles (discussed in Chapter 9) The fibro-osseous lesions will then be subdivided into the three most common lesions involving the frontal sinus: Osteoma Ossifying fibroma Fibrous dysplasia Each of these tumors varies with regard to risk of recurrence, degree of aggressiveness, and potential for malignant degeneration. Therefore, the primary management of each lesion will take these factors into consideration.