188 | Frontal sinus osteomas in the mummy of a poor clare nun from Fara in Sabina (17th-18th century)

Luca Ventura¹, Federico Bruno², Veronica Forte¹, Nadia Gabriele¹, Irene Faenza³, Enrico Petrella⁴, Gianandrea Pasquinelli⁵, Mirko Traversari⁵ | ¹UOC di Anatomia Patologica, Ospedale San Salvatore, L’Aquila, Italy; ²UOC di Neuroradiologia e Radiologia Interventistica, Ospedale San Salvatore, L’Aquila, Italy; ³Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Alma Mater Studiorum Università di Bologna, Italy; ⁴Dipartimento di Radiologia, AUSL Romagna, Ospedale Morgagni-Pierantoni, Forlì, Italy; ⁵Dipartimento di Scienze Mediche e Chirurgiche DIMEC, Alma Mater Studiorum Università di Bologna, Italy.

Osteomas of the paranasal sinuses originate from the sinus wall and grow into the sinus lumen. They are traditionally named after the sinus in which they are located. The advent and widespread use of computed tomography (CT) have enabled the detection of increasingly smaller and asymptomatic osteomas in modern clinical practice, and have also provided a powerful, non-invasive tool for identifying these lesions in ancient human remains. The mummified bodies of the Poor Clares Hermits monastic community of Fara in Sabina belonged to Franciscan nuns who followed the first Rule of Saint Clare, characterized by strict seclusion, ascetic living conditions, and absolute obedience to the ecclesiastical hierarchies. As a part of an interdisciplinary paleopathological investigation, we report two frontal sinus osteomas incidentally identified through CT imaging in one of these mummies. The mummy underwent a detailed external examination followed by total-body CT scanning, including multiplanar reconstructions and three-dimensional volume rendering. The individual was a woman over 50 years of age at death, showing evidence of poor dental health, including advanced periodontal disease and multiple periapical cysts, as well as severe degenerative changes affecting the spine, hips, and patellofemoral joints. The conservative diagnostic work-up revealed a double osteoma of the left frontal sinus: one lesion located in the fronto-ethmoidal recess, measuring 7 mm in its greatest diameter, and a second smaller lesion located on the anterior wall of the frontal sinus, measuring 4 mm. No signs of local complications or bone remodeling were observed. Frontal sinus osteoma remains an under-recognized condition in paleopathology, most often reported as an incidental finding in broken skulls or following radiological examination. A comprehensive review of the paleopathological literature allowed us to identify 8 cases (male:female ratio 6:2) of frontal sinus osteoma from Europe and Egypt, dating from the 4th century BC to the 16th century AD. An additional case has been described in a Neanderthal individual. Furthermore, frontal sinus or ethmoidal cells osteomas have been reported in approximately 3% of 273 Egyptian mummies dating to the 15^th century BC, although without detailed descriptions. The present case represents the ninth well-documented example of frontal sinus osteoma in mummified or skeletal remains, the third reported in a female individual, the second case of a double lesion, and the most recent chronologically.