OBJECTIVES: To present a rare case of a large ossifying fibroma of the frontoethmoid sinus and describe our experience with the clinical presentation, diagnosis, management dilemmas, surgical approach and outcome of our patient.

METHODS:
Design: Case Report
Setting: Tertiary Government General Hospital
Patient: One

RESULTS: A 29-year-old housewife consulted with a large left frontoethmoidal mass of 20 years duration causing significant facial deformity, left eye proptosis, headache and psychosocial distress. Initial CT scans and MRI revealed a well-encapsulated mass occupying the frontoethmoid sinus, left orbit and anterior cranial fossa and subsequent surgical management involved three important aspects: 1) Wide extirpation of the tumor; 2) Preservation of the brain, left orbital contents and function; and 3) Reconstruction of the facial defect using calvarial bone graft, abdominal fat and temporalis muscle flaps.

CONCLUSION: A large ossifying fibroma of the frontoethmoidal sinus threatens the integrity of the vital structures it compresses and poses compelling diagnostic and surgical challenges. Adequate imaging, multidisciplinary planning and surgical expertise are needed to ensure a successful outcome.