Osteomas are slow-growing tumors of the paranasal sinuses, usually found in the frontal and ethmoidal sinus. In many cases, these tumors are discovered by chance or after an imagistic exam for a non-responsive to medical treatment headache. In asymptomatic tumors, conservative treatment is indicated, while in big tumors with complications the gold standard is surgical resection of the tumor. We present two cases of rather similar anterior ethmoidal osteomas in which the therapeutic management was decided according to the symptomatology of the patient and the imagistic CT exam. We decided different ways of treatment for the two cases based on the CT scan, which has a major role in predicting intraoperative complications during endoscopic sinus surgery.