Paranasal sinus osteomas are slowly growing and frequently asymptomatic benign tumors. Surgery is the treatment method, and the approach may vary according to many factors about the tumor. The prominent locations of tumors were in the fron- tal sinuses and in the ethmoid sinus. The most common complaint was a headache. The diagnosis was made by paranasal computed tomography in all patients. This report describes the approach to managing osteoma in the paranasal region in 13 patients. Information on demographic features, the clinical presentation of the cases, radiographical outcomes, and surgical procedures were gathered and analyzed. Five patients were operated on endoscopic technique, six with osteoplastic flap technique, and two with a combined approach. Symptomatic osteomas require surgery. The surgery considers the localiza- tion, size of the lesion, and the experience of the surgeon.