title: Frontal osteomas: standardising therapeutic indications.
abstract: BACKGROUND
  We believe the currently accepted indications for frontal osteoma surgery are inappropriate. We propose a new osteoma classification system, below, in order to standardise surgical decisions.
  
  
  METHODS
  Osteomas were classified based on: relationship of tumour mass to sinus size; tumour proximity to the infundibulum, destruction of sinus walls, and complications. Forty-five osteoma cases were thus classified (1971-2007), 29 of which underwent surgery (64.44 per cent).
  
  
  RESULTS
  Three stages were thus derived: I, tumour/air fraction less than one-third, tumour distant from the infundibulum, no sinusitis, and no complications (18 patients (40 per cent)); II, tumour/air fraction one-third to one-half, no infundibular obstruction, no bone destruction, no sinusitis, and no complications (six (13.33 per cent)); and III, tumour/air fraction more than one-half, partial or total infundibular obstruction, sinusitis, bone destruction, and/or complications (21 (46.67 per cent)).
  
  
  CONCLUSIONS
  Study findings suggest the following surgical indications: stage I, no surgery required, implement monitoring protocol; stage II, implement monitoring protocol, surgery may be required depending on tumour severity and general patient condition; and stage III, surgery always required. This system provides a method of standardising osteoma surgical decisions.
authors.affiliation: Department of Otolaryngology, Rio Hortega Hospital, Valladolid University Hospital, Valladolid University, Spain. gilcarsa@telefonica.net
authors.forename: L M
authors.initials: LM
authors.lastname: Gil-Carcedo
authors.forename: E S
authors.initials: ES
authors.lastname: Gil-Carcedo
authors.forename: L A
authors.initials: LA
authors.lastname: Vallejo
authors.forename: J M
authors.initials: JM
authors.lastname: de Campos
authors.forename: D
authors.initials: D
authors.lastname: Herrero
mesh_terms: D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003661:Decision Support Techniques; D004724:Endoscopy; D005260:Female; D005626:Frontal Sinus / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D059747:Nasal Surgical Procedures / Q000592:standards; D009367:Neoplasm Staging; D010016:Osteoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011859:Radiography