Sinus osteoma is one of the most common benign tumors of the sinuses. Most sinus osteomas are slow growing, do not cause clinical symptoms, and are occasionally detected on radiographs or CT. Sinus osteoma is reported to be found in about 1% of sinus X-rays and 3% of sinus CT films. Most sinus osteomas occur in the frontal sinus, followed by the septal sinus, maxillary sinus, and pterygoid sinus. Sinus osteomas without clinical symptoms do not require treatment, but surgical treatment is needed when they are complicated by chronic nasal 2 sinusitis, sinus mucus cysts, proptosis, and intracranial infections. The incidence of septal sinus osteoma is lower than that of frontal sinus osteoma, but it is more likely to obstruct the drainage channels of the septal sinus and present with corresponding clinical symptoms. The traditional surgical approaches for removal of septal sinus osteoma include open transnasal surgery, such as lateral nasal incision, combined craniofacial approach and other procedures. The trend of nasal endoscopic surgery and combined pathways (open surgery plus nasal endoscopic surgery) has been developed in the last 20 years. The development of nasal endoscopic surgery techniques, high-resolution CT scanning and 3D reconstruction techniques, navigation techniques and electric drills have provided the technology and equipment to remove septal sinus osteoma via the endonasal pathway.