Auris Nasus Larynx 27 (2000) 285–287 Case report Huge osteoma of the frontoethmoidal sinus with secondary brain abscess Mehmet Koyuncu a, *, U  mit Belet b , Teoman S ¸es ¸en a , Yu ¨ cel Tanyeri a , Mahmut S ¸ ims ¸ek a a Department of Otorhinolaryngology, Head and Neck Surgery, Ondokuz Mayy ´s Uniersity, School of Medicine, 55139 Samsun, Turkey b Department of Radiology5, Ondokuz Mayy ´s Uniersity, School of Medicine, 55139 Samsun, Turkey Received 10 November 1999; received in revised form 28 December 1999; accepted 28 January 2000 Abstract Osteomas of paranasal sinuses are usually asymptomatic. When enlarged, they may cause serious complications. We report a case of huge frontoethmoidal osteoma associated with brain abscess. If an osteoma associated with an intracerebral pathology is detected, it should be remembered that this could have been a complication of the osteoma and a detailed radiological examination should be performed to show the extent of the osteoma and to confirm any defect at the posterior wall of the sinus which may lead intracerebral complications. Such an osteoma should be operated after the abscess was resolved and patient became stable neurologically. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Osteoma; Brain abscess www.elsevier.com/locate/anl 1. Introduction Osteomas of the paranasal sinuses are uncommon. They are benign tumors and usually found in the frontal sinus, and less often in the ethmoid, maxillary and sphenoid sinuses. They are usually asymptomatic and diagnosed incidentally by sinus roentgenograms [1]. As they enlarge, they may produce a variety of symp- toms and complications depending on their location. Brain abscess is a rare complication of osteomas with a reported incidence of less than 1% during examination of computed tomography (CT) [2]. We present a case with huge osteoma of the fron- toethmoidal sinus with brain abscess. 2. Case report A 38-year old man presented with 15 years of headache which became prominent for the last 45 days. Neurologic and opthalmologic examinations were nor- mal. Axial unenhanced cranial CT was normal except a paranasal osteoma seen at the lower most slice. The patient was then referred to otorhinolaryngology de- partment. Otorhinolaryngological examination was normal. Axial-coronal unenhanced paranasal sinus CT showed a 35 ×45 ×30 mm, lobular, homogenous and hyperdens giant ethmoidal osteoma extending into the frontal sinus (Fig. 1). In addition, another ill-defined, relatively hypodens mass with a diameter of 50 mm was detected in the frontal lobe. On performed cranial magnetic resonance (MR) imaging the mass showed marginal enhancement, and there was edema around the lesion which caused shift effect and compression of right frontal horn (Fig. 2). Since the clinical findings were incompatible with an infectious process, the MR imaging findings of the lesion suggested primarily a brain tumor, either primary or metastatic. The patient was operated by neurosurgery department. An intracra- nial abscess was seen and it was removed together with capsule. Histopathological diagnosis of specimen was reported as infectious process. Culture from material revealed Staphylococcus aereus. * Corresponding author. Tel.: +90-362-4576000; fax: +90-362- 4576041. E-mail address: sevgimehmet@yahoo.com (M. Koyuncu) 0385-8146/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII:S0385-8146(00)00063-8