Frontal sinus osteoplastic flap: is it relevant today?

Archana Shah,Vedula P Saha,Somnath Saha,Moushumi Sengupta

doi:10.4103/1012-5574.244903

Abstract

In the present era where frontal sinus surgery is synonymous with functional endoscopic sinus surgery, we present a case series comprising six cases of varied frontal sinus pathology that were managed with an external approach using an osteoplastic flap technique. The study was carried out in the ENT Department of Calcutta National Medical College, a tertiary care center in Kolkata. A unilateral osteoplastic flap approach was adopted in three cases, of which two were reported as osteomas and one was that of inverted papilloma. Bicoronal osteoplastic flap was raised in another group, which included a case of communited fracture of the anterior wall of the frontal sinus with obvious cosmetic facial deformity, a case of fracture of the posterior wall of the frontal sinus with traumatic cerebrospinal fluid rhinorrhea with pneumoencephalus, and a case of plasmacytoma of the frontal sinus. The mean follow-up period ranged from 1 to 3 years. There was no recurrence of disease and no significant postoperative complications have been reported during the follow-up period so far.

Highlights

Frontal sinus surgery has come a long way since eighteenth century when the first frontal sinus procedure was described in 1750 [1]
Recent advances in imaging and endoscopic techniques have led to resurgence in intranasal endoscopic procedures, in certain frontal sinus diseases such as frontal/frontoethmoid osteoma, posterior table erosion, failed endoscopic approaches, laterally placed disease, and absent or distorted intranasal landmarks, open approach is still the modality of choice [2]
Case history After taking a relevant and informed consent from the patients or guardian, each patient was treated under general anesthesia. Both cases of osteoma were managed with a unilateral osteoplastic flap raised by means of a supraorbital incision that extended to the level of nasal process of the frontal bone, followed by elevation of the musculocutaneous flap superiorly (Fig. 1a–c and Table 1)

Summary

Introduction

Frontal sinus surgery has come a long way since eighteenth century when the first frontal sinus procedure was described in 1750 [1]. Case history After taking a relevant and informed consent from the patients or guardian (whichever applicable), each patient was treated under general anesthesia Both cases of osteoma were managed with a unilateral osteoplastic flap raised by means of a supraorbital incision that extended to the level of nasal process of the frontal bone, followed by elevation of the musculocutaneous flap superiorly (Fig. 1a–c and Table 1). The anterior wall of the frontal sinus was downfractured and elevated as inferiorly based bony flap after joining the burr holes drilled along the outline of the frontal sinus with an ∼30° angulation directed toward the Frontal sinus maintained to ensure a wide surface for the later replacement of the bony flap

Discussion

Conflicts of interest

Conclusion