Introduction: Osseous lesions of the nose and paranasal sinuses are rare and slow-growing tumors that can be benign or malignant. Benign lesions share similarities in clinical, radiological, and histological presentations, yet they exhibit different behaviors. The most frequent benign osseous lesion type is osteoma; others are fibrous dysplasia (FD) and ossifying fibroma. Ewing's sarcoma of the head and neck region constitutes 1–4% of all Ewing's sarcoma, mandible and skull base being the most common and primary sinonasal location being rare. Methods: A retrospective study was done reviewing the records of patients diagnosed with osseous lesions of the nose and PNS over 7 years from August 2013 to August 2020 in our tertiary care center. Results: A total of 16 osseous lesions were noted of which 12 (75%) patients were diagnosed with benign lesions and 4 (25%) with malignant lesions. Of the benign lesions, osteomas constituted 58% (7 patients), FD 17% (2 patients), ossifying fibroma 17% (2 patients), and chondromesenchymal hamartoma 8% (1 patient). Of the malignant lesions, we experienced 75% (3 patients) Ewing's sarcoma and 25% chondrosarcoma (1 patient). All the cases were managed with a transnasal endoscopic approach except for one with ossifying fibroma that required an external approach. Conclusion: An early diagnosis and appropriate intervention with long-term surveillance will help to increase the quality of life. Observation and regular imaging with surgical intervention, when required, remain the mainstay of treatment for benign lesions. Our patients are under regular follow-up with no evidence of recurrence to date.