Optimizing surgical strategies for frontal sinus osteomas: a proposal for classification

Purpose: Frontal sinus osteomas are benign tumors that often require surgical resection due to their proximity to critical anatomical structures. The surgical approach can vary significantly depending on the size, location, and extent of involvement of these structures. Currently, no universally accepted classification system exists to guide the surgical management of frontal sinus osteomas. This study proposes a classification system based on these factors, with the objective of providing a standardized approach for selecting the most appropriate surgical techniques. Methods: A retrospective analysis was conducted on all patients who underwent surgical resection of frontal sinus osteomas at a single institution from 2012 to 2024. Osteomas were categorized into three grades (I, II, and III) based on size, location, and anatomical features. Surgical outcomes were analyzed in relation to the osteoma classification. Results: Fifty-two patients were included in the study. Of these, 41 (78.8%) patients were treated using an endoscopic approach, 7 (13.5%) with an open approach, and 4 (7.7%) with a combined approach. According to the classification, 25 (48.1%) osteomas were categorized as grade I, 14 (26.9%) as grade II, 13 (25.0%) as grade III. Grade I osteomas were predominantly managed with endoscopic techniques, while grade II osteomas required extended endoscopic approaches. Grade III necessitated open or combined approaches. Conclusion: This classification system provides a structured approach for determining the optimal surgical method for frontal sinus osteomas, aiming to reduce variability in treatment and improve patient outcomes.