Maxillary Sinus Osteoma — ORE Part 1 MCQ

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ModerateRadiology & ImagingMaxillary Sinus OsteomaORE Part 1

A 40-year-old man presents with long-standing unilateral nasal obstruction. An OPG shows a large radiopaque mass in the left maxillary sinus. CT imaging shows a well-defined, dense bony mass arising from the sinus wall. What is the most likely diagnosis?

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Correct answer: B — Osteoma of the maxillary sinus

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

The correct answer is A (Osteoma of the maxillary sinus). Osteomas are benign, slow-growing bone tumours characterised by proliferation of dense bone, presenting as well-defined radiopaque masses on radiographs and CT. The clinical presentation of unilateral nasal obstruction results from the mass obstructing the sinus orifice—a recognised mode of presentation. The key discriminating feature is the well-defined, uniformly dense bony mass arising from the sinus wall. Fibrous dysplasia (B) shows mixed radiopaque-radiolucent ('ground glass') appearance, not uniform density. Antral polyps (C) and keratocysts (D) are radiolucent lesions, not radiopaque. Maxillary sinus carcinoma (E) presents with irregular bone destruction and infiltration, not a sharply circumscribed bony lesion. The combination of radiopacity, well-defined margins, dense bony composition, and functional obstruction make osteoma the single best answer.

Reference: Craniofacial Osteomas: From Diagnosis to Therapy. PubMed Central (PMC8658100). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658100/; An Isolated Laminar Osteoma Arising in the Maxillary Sinus. PubMed (PMID: 36967573, 2023). https://pubmed.ncbi.nlm.nih.gov/36967573/