Twenty-eight cases of osteomas of the paranasal sinuses are reviewed. The most common localization was the frontal sinus, secondly the ethmoid sinus. Primary osteomas of the maxillary and sphenoid sinus are very rare. The most common complaint was pain. Clinical examination revealed deformity of the forehead and/or face in 13 patients, seven had dislocation of the eyeball as well. In eight cases x-ray, including tomography, and operation showed exposed dura. This gives a potential risk of intracranial complications, demonstrated by one of our patients who had a defect in the dura, and consequently meningitis. Osteomas encroaching on neighboring structures should be extirpated, while smaller osteomas can be left in place provided that they are controlled regularly. Recurrences are rare. When operating we feel that satisfactory cosmetic and functional conditions count more than radicality.