Clinical Application of Cranialization of the Frontal Sinus

Chung, Seung Moon; Seo, Yeong Min

Abstract

Both frontal sinus ablation and osteoplastic frontal surgery with obliteration have limitations in treatment of injury to the frontal sinus that extends into the posterior wall and frontal lobes of the brain. In these problematic cases, cranialization of the frontal sinus is the method of choice. The purpose of the cranialization of the frontal sinus was as follows: (1) ablation of the sinus, precluding later infection or mucocele, mucopyocele formation (2) restoration of a normal aesthetic frontal bony contour (3) protection of frontal lobe by allowing space for the expansion of the edematous brain. From May 1999 to December 2003, we performed cranialization of involved frontal sinus in 23 patients who had malignant tumor, fibrous dysplasia, osteoma, mucoele, and fracture event in the frontal sinus on each other. After the frontal sinus was exposed through a bicoronal incision, the excision of posterior wall and removal of mucosa remaining on the floor of the sinus and residual anterior wall were done. The nasofrontal ducts were occluded with pericranial flap or/and bone source(R), or bone graft. Reconstruction of anterior wall was done with autogenous bone or/and bone source(R), or mesh plate, bone graft, and mesh plate with bone source(R).The average follow-up period was one and half years (from 1 year to 4 years).There were no serious complications including CNS infections, mucocele formation and CSF leakage, with an exception of one person who was expired of recurrence of skull base tumor. Also, the overall functional and aesthetic outcome was excellent except one case in which there was irregularity in the frontal area. The cranialization of the frontal sinus is a safe surgical procedure without complications if prevented.