Osteomas are common benign tumours of the paranasal sinuses, but are usually asymptomatic and found as a coincidental finding during routine radiological investigations. We present a case report of a patient with an isolated osteoma of the middle turbinate presenting with unilateral nasal obstruction which required removal via a lateral rhinotomy approach. The aetiology, pathology and presenting features of these tumours are reviewed and their subsequent management discussed. In particular, adequate pre-operative radiological assessment to determine involvement of the cribriform plate region by computerized axial tomography (CAT Scanning) is emphasized since this may indicate the need for a cranio-facial surgical approach rather than a lateral rhinotomy to achieve complete removal.