Contemporary Management of Frontal Osteomyelitis

Abstract

Objectives: Frontal sinus osteomyelitis is a severe complication that can result from chronic rhinosinusitis, from trauma, or as a complication of reconstruction or obliteration of the frontal sinus. The objective of the current study is to evaluate the contemporary management of frontal sinus osteomyelitis in light of recent pervasive advancements in endoscopic experience. Methods: Review of a prospectively collected database of patients with frontal sinus pathology was performed from 2008-2013, and data from individuals with frontal sinus osteomyelitis were collected regarding demographics, etiology, surgical technique, adjunctive medical treatments, complications, and clinical follow-up. Results: Eleven patients (average age, 43.6 years; range, 8-84 years) were included in the study. An open approach was used in 5 patients (2 osteoplastic flaps, 2 Reidel procedures, 1 cranialization). Four patients underwent completely endoscopic approaches (2 Draf IIB, 2 Draf III), while 2 individuals had combined procedures (Lynch/Draf III, osteoplastic flap/Draf III). Osteomyelitis was secondary to complications from previous surgery (n = 6) and acute/chronic rhinosinusitis (n = 5). An open approach was used in all cases of osteomyelitis that formed as a result of prior surgery. All patients received 6 weeks of intravenous antibiotics. Average clinical follow-up was 8 months with no revision procedures. Conclusions: Endoscopic, endoscopic-assisted, and open approaches were used successfully in the current series of patients with osteomyelitis of the frontal bone. While the advent of endoscopic techniques allows an additional surgical treatment option, it is important to select patients appropriately as open procedures continue to have a role in the treatment algorithm.