Nasoorbital Osteoma Presenting as Valsalva-induced Orbital Emphysema

An 18-year-old female athlete with a history of multiple traumatic concussions presented with complaints of recurrent bouts of right periorbital swelling that arose with Valsalva maneuvers such as nose-blowing or sneezing. The swelling resolved over hours to days. A CT scan of the sinuses revealed an osteoma originating from the right ethmoid roof involving the frontal recess and projecting into the orbit. She underwent excision of the osteoma via endoscopic transnasal and transcaruncular anterior orbitotomy approaches without complication.