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 22 year old male presented with nasal obstruction, fontal headache, diplopia and imbalance. His symptoms were severe and poorly responsive to medical management and CT imaging revealed a large osteoma (59 x 33 x 32 mm), arising within a pneumatised middle turbinate and extending into the nasopharynx. The patient underwent urgent image-guided modified endoscopic Lothrop’s procedure which facilitated complete excision of the osteoma. To date only 8 previous cases of middle turbinate osteomalacia have been described. The presented case described the first experience of endoscopic excision with a Lothrop’s approach.