BACKGROUND. The most frequent benign nasal tumor is the osteoma. It is commonly asymptomatic and usually an incidental finding and can be caused by multiple factors. The therapeutic approach for symptomatic osteomas is strictly surgical. CASE REPORT. The authors present a patient with giant ethmoido-frontal osteoma, causing the compression of the ocular globe and the right frontal lobe. Considering the intracranial extension, a combined surgical team consisting of an ENT surgeon and neurosurgeon decided to deal with the case. The tumoral mass was removed with no recurrence after a follow-up of two years. CONCLUSION. Surgery via external and endoscopic approach aims to completely resect the osteoma with frontal sinus origin and orbital or intracranial extension.