Background: Facial fractures are common in emergency and trauma care, with age and sex known to influence fracture patterns, injury mechanisms, and treatment approaches. However, detailed comparative data analyzing these demographic variables separately remain limited. Methods: In this retrospective single-center study, we analyzed 561 patients with radiologically confirmed facial fractures who were treated between January 2021 and December 2022. Patients were stratified by sex and age (<50 vs. ≥50 years). Fracture types, trauma causes, and treatment modalities were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Results: Male patients comprised 60.1% of the cohort. Interpersonal violence, alcohol-related trauma, and sports injuries were significantly more frequent in males, while females experienced more falls and syncopes (p < 0.001). Although most fracture types did not differ significantly by sex, female patients underwent surgical treatment significantly less often than males (OR = 0.45, 95% CI: 0.32–0.64, p < 0.001). Patients over 50 years were significantly less likely to suffer mandibular fractures (OR = 0.59, 95% CI: 0.40–0.88, p = 0.009), while frontal sinus fractures were more common in older individuals (OR = 4.77, 95% CI: 1.02–22.27, p = 0.029). Younger patients more often experienced interpersonal violence, alcohol-related incidents, and received operative care, whereas falls and conservative treatment were more frequent among older individuals. Conclusions: Age and sex significantly influence the epidemiology and management of facial fractures. Understanding these demographic differences can guide targeted prevention strategies and assist clinical decision-making in facial trauma care.

Objective: To establish a predictive system for aerosol drug deposition by integrating computational fluid dynamics (CFD) and artificial intelligence (AI) modeling, and to propose optimized strategies for intranasal drug delivery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after various Draf procedures. Methods: Post-operative 3D nasal airway models of Draf Ⅱa, Ⅱb, and Ⅲ were reconstructed based on CT data from a CRSwNP patient treated at the Second Affiliated Hospital of Xi'an Jiaotong University. CFD simulations were employed to assess the impact of inspiratory flow rates (15, 30, and 45 L/min), nebulizer oxygen flow rates (6 and 8 L/min), and particle sizes (5-50 μm) on drug deposition efficiency (DE) across three target areas (TAs): the frontal sinus (TA1), the olfactory region and ethmoid sinus (TA2), and the respiratory zone (TA3). Based on 540 sets of CFD data, XGBoost machine learning models were developed to predict regional DE and interpret variable importance. Statistical analysis was performed using SPSS 21.0. Results: Regarding particle size, optimal DE was observed with 25 μm drug particles for TA1 (DEmax=30.19%), 15-25 μm for TA2 (27.55%), and 20-35 μm for TA3 (25.77%). Nowadays, clinically available nebulizers producing small particles (1-5 μm) generated extremely low DE in TA1 (<1%) and TA2 (<2%). Among the surgical variants, Draf Ⅲ provided the largest frontal sinus ostium with the highest airflow velocity (1.53 m/s), resulting in the highest DE of TA1 (τ=0.75, P<0.001). However, Draf IIb achieved the highest cumulative DE across all three TAs (τ=0.40, P=0.001). The XGBoost models exhibited excellent predictive performance (R²: 0.81-0.98). Feature importance analysis and SHapley Additive exPlanations (SHAP) values revealed that drug particle size was the primary determinant of cumulative DE across all three TAs (accounting for >40% of importance), while surgical procedure had a dominant influence on the DE of TA1 (accounting for >40% of importance), with the Draf Ⅲ surgery significantly promoting frontal sinus drug deposition. Conclusion: By integrating CFD and AI techniques, this study demonstrates that the Draf III procedure significantly improves frontal sinus ventilation and inhances drug deposition. Medium-sized particles (25 μm) combined with low-to-moderate inspiratory flow rates (15-30 L/min) are optimal for nasal-targeted aerosol therapy.

Sinonasal osteoblastoma is a rare benign tumor that can involve critical structures like the skull base and orbit. This study presents a case series and literature review to describe clinical features, surgical management, and outcomes. Five patients with sinonasal osteoblastoma were treated endoscopically between 2020 and 2025. Clinical data, imaging, surgical approach, histopathology, and follow-up outcomes were reviewed. A PubMed search was conducted to identify previously reported cases. Patients ranged from 12 to 57 years old. Tumors most commonly involved the ethmoid sinus and presented with nasal obstruction, headache, or epistaxis. Four underwent total endoscopic resection; one had subtotal removal due to frontal sinus involvement. Histopathology revealed three conventional and two aggressive osteoblastomas. No recurrences or major complications occurred over a follow-up of two to five years. Endoscopic resection appears to be a safe and effective approach for sinonasal osteoblastomas, even in cases with skull base or orbital extension. This series supports the growing role of minimally invasive surgery in managing these uncommon tumors.

Tomographic characteristics of the frontal sinus in a public hospital in Peru.

Bioactive glass (BAG) S53P4 is a synthetic bone substitute consisting of oxides of silicon, sodium, calcium and phosphorus and exhibits both osteoconductive and antibacterial properties. Clinically it has been used in the treatment of benign bone tumor surgery, in spine surgery, in trauma surgery, in frontal sinus surgery, in diabetic foot osteomyelitis surgery, in mastoid surgery, in oral and maxillofacial surgery, and in the treatment of bone infections with excellent clinical outcomes. A systematic review following PRISMA guidelines is performed to evaluate the level of evidence, clinical efficacy, and safety of BAG S53P4 as a bone graft substitute in the treatment of bone defects and infected bone. Clinical studies published between 1990 until 2024 are extracted and analyzed (N = 99). The highest level of clinical evidence (L1-L2) of successful use of BAG S53P4 is found in the treatment of benign bone tumor surgery (N = 5), in oral and maxillofacial surgery (N = 5), in the treatment of bone infection (N = 6), in spinal surgery (N = 3), and in trauma surgery (N = 3). The highest evidence on successful treatment in respect to the number of publications on BAG S53P4 are found in the categories of infection treatment (N = 24) and in mastoid surgery (N = 30). Derived from this systematic literature review and level of evidence assessment, BAG S53P4 is a safe and effective alternative to autograft bone and offers excellent long-term outcomes in various clinical indications when bone grafts are needed. In the management of osteomyelitis in infected non-unions, mastoid surgery and diabetic foot, BAG S53P4 demonstrates high infection eradication rates and successful bone healing. Considering the increasing incidence of microbial resistance to antibiotics its role may become critical in the fight against antimicrobial resistance.

Evaluation of validity and reliability of quantitative Cervical Vertebral Maturation Index (QCVMI): A cross-sectional study.

3D reconstructed paranasal sinuses are gaining increasing attention for personal identification. This study assessed the consistency between Dolphin Imaging and Mimics in 3D paranasal sinus reconstruction and the comparative efficacy of combined frontal, sphenoid, and maxillary sinuses versus isolated frontal sinus for personal identification through simulation of ante-mortem and post-mortem data. Retrospective multi-slice CT scans from 100 patients (21-84 years; 50 for each gender) were used to generate 3D models of combined sinuses via both software. Three groups were established: (1) 100 matched pairs from the same individual from both software; (2) 100 mismatched pairs from two different individuals from Dolphin Imaging; and (3) 100 mismatched pairs from two different individuals from Mimics. Root mean square (RMS) point-to-point distances were calculated using Geomagic Qualify. The software consistency was assessed through comparing RMS values (Group 1 versus established frontal sinus matches; Group 2 versus Group 3). Group 1 (males: RMS = 0.399 ± 0.14mm; females: RMS = 0.373 ± 0.14mm) demonstrated consistency with established frontal sinus matches (RMS = 0.390 ± 0.25mm). Group 2 (males: RMS = 4.251 ± 2.01mm; females: RMS = 4.166 ± 1.63mm) and 3 (males: 4.187 ± 1.88mm; females: 4.093 ± 1.66mm) showed no significant differences, and both aligned with established frontal sinus mismatches (RMS = 4.49 ± 2.69mm). Significant RMS differences were observed between matches and mismatches (p < 0.05). No significant differences were found according to gender (p > 0.05). This study confirmed comparable reconstruction capabilities between Dolphin Imaging and Mimics for paranasal sinuses and provided combined frontal, sphenoid, and maxillary sinuses as novel, reliable evidence for forensic 3D comparative identification.

Frontal recess is an important region in endoscopic surgery in terms of its complex anatomic structure and excessive pneumatized cell variations. With the International Frontal Sinus Anatomy Classification (IFAC), classification and nomenclature of cellular variations in this region have been facilitated. The aim of the present study was to determine the incidence of frontal recess cell variations in computed tomography (CT) according to IFAC and to investigate the possible effect of these cells on the development of frontal sinusitis. In this observational, retrospective, and cross-sectional study, the frontal recess cell variations on both sides of the patients who underwent paranasal sinus CT examination were analyzed according to IFAC, and the possible relationship between these cellular variations and the presence of frontal sinusitis was evaluated by statistical methods. A total of 428 sides of 214 paranasal sinus computed tomography were examined. Agger nasi cell (ANC) was observed in 90.8%, while supra agger cell (SAC) were detected in 57.9% and supra agger frontal cell (SAFC) in 20.5%. Supra bulla cell (SBC) were observed in 80.1% of the sides and supra bulla frontal cell (SBFC) in 19.3%. Supraorbital ethmoid cell (SOEC) were detected on the 41.8% of sides, while frontal septal cells (FSCs) were observed in the 28.9%. The results of the present study showed that the prevalence of cells, especially other than ANC cells varies between populations. In addition, the presence of SAC, SAFC, SBC, SBFC, and SOEC appeared to be associated with a tendency to the development of frontal sinusitis.

This study aimed to evaluate the efficacy of platelet-rich plasma (PRP), a biologic agent that facilitates tissue regeneration and wound healing, in improving postoperative outcomes of frontal sinus ostium (FSO) and need for postoperative intervention. A prospective, randomised controlled trial included chronic rhinosinusitis (CRS) patients undergoing bilateral endoscopic frontal sinus surgery. PRP-soaked absorbable hemostat was applied to the frontal sinus ostium on the randomised side, while a plain absorbable hemostat was used on the control side. Endoscopic evaluations were conducted intraoperatively (baseline), and at 30 and 90 days postoperatively to assess the FSO area, FSO patency, inflammatory visual analog scale (VAS) score, presence of polypoid edema, adhesion/scarring grade, and the need for postoperative interventions. Thirty participants were enrolled and PRP was applied to 30 frontal sinus ostia on randomised side. On 30-day post-ESS PRP significantly improved inflammatory VAS score (p = 0.041), reduced polypoid edema (odds ratio (OR) 0.49; 95% CI: 0.24, 0.98) and adhesion scarring (OR 0.33; 95% CI: 0.15, 0.74), and improved the need of postoperative intervention compared to the control (risk ratio (RR) 0.25; 95% CI: 0.11, 0.58). On 90-day post-ESS, PRP significantly reduced polypoid edema (OR 0.35; 95% CI: 0.17, 0.67), and adhesion scarring (OR 0.20; 95% CI 0.07, 0.52) compared to the control. The FSO area changes and patency grade were not significantly different between groups. The PRP application following frontal sinusotomy improved the inflammatory VAS score, polypoid edema and adhesion scarring grades, and reduces the need for oral steroid intervention.

Abstract Background The frontal sinus is among the most anatomically complex regions to manage in endoscopic sinus surgery, with high risks of postoperative restenosis. This study aimed to evaluate the safety and efficacy of biodegradable, drug-eluting stents (Propel) compared to traditional non-drug-eluting stents (Merocel and Rains) in maintaining frontal sinus ostium patency following functional endoscopic sinus surgery (FESS). Methods A prospective comparative study was conducted at Helwan University Hospital (Badr Hospital), enrolling 34 adult patients with various frontal sinus pathologies at high risk of restenosis. Participants were randomized into two groups: the study group ( n = 17) received the Propel stent, while the control group ( n = 17) received either Merocel or Rains stents. Patients were followed for 6 months postoperatively with clinical, endoscopic, and radiological assessments. Primary outcomes included frontal ostium patency, while secondary outcomes assessed complications such as stenosis, obstruction, adhesions, polyp formation, mucosal healing, and inflammation. Results Baseline characteristics and surgical indications were comparable between groups. At 6 months, the Propel group demonstrated significantly higher ostium patency (100% vs. 41.18%, p = 0.001), a complete absence of adhesions (0% vs. 58.82%, p = 0.001), and lower rates of polyp formation (0% vs. 23.53%, p = 0.033). Sinonasal mucosal healing was higher in the Propel group (94.12% vs. 76.47%, p = 0.168), though not statistically significant. Trends toward reduced inflammation and retained secretions favored the Propel group. All Propel stents were entirely absorbed by 6 months without the need for removal. Conclusion Biodegradable drug-eluting Propel stents significantly improve postoperative outcomes in frontal sinus surgery by enhancing ostium patency, reducing adhesions and polyp recurrence, and promoting mucosal healing. These findings support the selective use of drug-eluting stents in high-risk patients; however, larger multicenter trials with longer follow-up are needed to confirm the long-term benefits.

Abstract OBJECTIVE To synthesize existing literature on JPOF and present a detailed case of a 22-year-old woman with maxillary, frontal, and ethmoidal sinus involvement, highlighting diagnostic features, surgical management, and short-term outcomes. METHODS A review of articles on JPOF was conducted, focusing on clinical presentation, radiologic findings, histopathology, and treatment strategies. Concurrently, we analyzed the case of a 22-year-old female who presented with progressive facial swelling and nasal obstruction. Diagnostic work-up included computed tomography (CT) and magnetic resonance imaging (MRI), followed by histopathological confirmation via endoscopic biopsy. The patient underwent endoscopic-assisted excision with intraoperative navigation to ensure complete lesion removal while preserving adjacent structures. RESULTS Imaging revealed a well-demarcated, expansile lesion with internal calcifications. Histology demonstrated psammoma-like bodies and fibroblastic proliferation, confirming JPOF. Surgical excision achieved clear margins without intraoperative complications. At three months postoperatively, the patient remained symptom-free with no radiologic evidence of recurrence. Literature review underscores the importance of early diagnosis, meticulous surgical planning, and the role of advanced imaging in minimizing morbidity. CONCLUSION JPOF demands a high index of suspicion, accurate imaging, and histopathology for diagnosis. Endoscopic-assisted resection with navigation yields favorable short-term outcomes. Given the lesion’s recurrence risk, long-term surveillance and further research into its molecular pathogenesis are essential to optimize management.

Aim Bioactive glass (BAG), S53P4 is a bone substitute with documented antibacterial properties, attributed to a pH-altering effect and osmotic pressure in the vicinity of the glass. Clinically, granules of BAG S53P4 are used in various applications in the treatment of bone infections; in osteomyelitis, frontal sinus -, oral and maxillofacial -, mastoid - and diabetic foot surgery. The increasing antimicrobial resistance, today considered a global treat, has subsequently increased the interest in bacteriophages in the treatment of infections. The aim of the study was to test different forms of BAG S53P4 against Staph aureus in combination with bacteriophages to evaluate the combined effect of BAG S53P4 and the bacteriophages in-vitro . Method First the bacteriophages were tested for tolerance to an increase in pH 2-12, due to the known surface reactions in solution of BAG S53P4, which after they were tested together with powder, granules and experimental scaffolds of BAG S53P4. Finally, bacteriophages, BAG S53P4 and the different forms of BAG S53P4 were tested together with Staph aureus . Results Bacteriophages tolerated an increase in pH in solution well both from the granules and the scaffolds, but not from the powder. BAG S53P4 powder alone killed most of the bacteria, followed by the granules and scaffolds. For granules, a slight difference in antibacterial efficacy was observed in favor of the combination of BAG S53P4 and bacteriophages, which was even more clearly observable for bacteriophages and scaffolds. Conclusions In an experimental setting including powder, granules and experimental scaffolds of BAG S53P4 and Staph. aureus combined with bacteriophages, an increased antibacterial effect was observed, for granules and scaffolds making the combination of bacteriophages and BAG S53P4 a promising tool in the treatment of challenging bone infections.

Chronic rhinosinusitis (CRS), marked by nasal mucosal inflammation, is a common condition often assessed via computed tomography (CT). However, the extent of airway opacification due to CRS-related inflammation remains incompletely quantified relative to healthy sinonasal anatomy. This preliminary study aims to quantify nasal and paranasal sinus volumes in CRS subjects, offering insights into the impact of inflammation on sinonasal airspace volumes. Anatomically accurate 3-dimensional sinonasal airspaces were reconstructed from CT images of 9 adult subjects with varying disease severity of CRS sans polyposis and 10 adult subjects with healthy normal sinonasal anatomy. Volumetric quantification of the sinonasal airspace volumes between subject groups were performed for comparison. Across all subjects, nasal cavity volume was 23% larger in the Normal group; although not statistically significant (P = .14), the effect size ( = -.28) indicated a small volumetric advantage. Similarly, maxillary and frontal sinuses were 12% and 61% larger in the Normal group, respectively, with effect sizes (maxillary: = -.16; frontal: = -.23) supporting this trend despite non-significant P-values (maxillary: P = .42; frontal: P = .24). Notably, female subjects with CRS exhibited significantly reduced maxillary and frontal sinus airspace volumes. As a result of inflammation, preliminary findings suggest that patients with CRS exhibit notably reduced airspace volumes compared to those considered "normal." Additionally, differences in airspace volumes between sexes, as supported by existing literature, were also noted.

Postoperative assessment of forehead contouring in facial feminization surgery.

To describe surgical fungal plaque debridement and clotrimazole 1% cream application via normograde sinoscopy (NS) and report short- and long-term outcomes in dogs with sinonasal aspergillosis (SNA). 18 client-owned dogs. This was a retrospective single-institution case series of dogs diagnosed with SNA and treated with NS. Signalment, history, physical examination, diagnostic and sinuscopic findings, topical treatment frequency, complications, and outcome were recorded. 18 dogs underwent NS for SNA treatment. The median age was 8.5 years. Unilateral disease (15 of 18) was more frequent than bilateral. Following direct access to the frontal sinus, debridement of fungal plaques was completed under direct visualization with a 2.4-mm, 30° arthroscope. Two topical cream instillations were performed in 17 of 18 cases, with a complete resolution of clinical signs recorded in 15 of 18 dogs. Re-treatment was achieved via percutaneous injection in dogs requiring more than 1 topical cream application. A small self-limiting swelling of the surgical wound was reported in 1 case. Re-treatment via percutaneous injection was a fast, well-tolerated, and low-morbidity procedure. Repeated debridement via NS was required in 4 dogs. Long-term follow-up documented an overall cure rate of 83.3% with no major complications. NS provided a safe approach for complete debridement of the frontal sinus with a comparable outcome to previously reported treatments. No major complications associated with the surgical procedure occurred. This technique allowed direct visualization and video-assisted debridement of fungal plaques. Normograde sinoscopy could be considered as a technique to enhance topical treatments for extensive frontal sinus aspergillosis.

IntroductionSinonasal mucormycosis is a fulminant, life-threatening, invasive fungal infection that emerged as an epidemic during the second wave of the coronavirus disease 2019 (COVID-19) pandemic in developing countries such as India. The objective of this study is to evaluate the role of frontal sinus endoscopy, to assess the disease extent in invasive frontal sinus mucormycosis, and to study the effectiveness of a combined approach involving endoscopic and external frontal sinusotomy among post-COVID-19 invasive sinonasal mucormycosis involving frontal sinuses.MethodsThis retrospective observational study included 11 patients with post-COVID-19 invasive sinonasal mucormycosis involving unilateral or bilateral frontal sinuses admitted to a quaternary care center from March 2021 to March 2022. Early diagnosis with classic nasal endoscopic findings and prompt surgical intervention with endoscopic sinonasal debridement combined with external frontal sinusotomy were performed for all 11 cases. Frontal sinus endoscopic findings are documented. The patients were followed up for a minimum period of one year, and the results are presented.ResultsFrontal sinus endoscopy revealed necrotic black frontal sinus mucosa with fungal growth (9%); pale frontal sinus mucosa studded with necrotic black spots (18%); pale frontal sinus mucosa with fungal debris (27%); inflamed frontal sinus mucosa with pus, fungal debris (18%), and granulations (18%); and prolapsed dura into the frontal sinus due to posterior frontal sinus wall erosion (9%). Six (55%) out of 11 patients recovered and were declared cured from the disease. Four (36%) out of 11 patients died within the first week of stage 1 surgical debridement. One patient (9%) was lost to follow-up after eight weeks of stage 1 surgical debridement. The combined approach involving endoscopic and external frontal sinusotomy provided complete local surgical clearance up to the lateral corners and the walls of the frontal sinuses, which are nasal endoscopically inaccessible.ConclusionFrontal sinus endoscopic findings explain the necessity of combining external with endoscopic approaches for frontal sinus involvement in invasive mucormycosis, which is otherwise inaccessible. The endoscopic findings in invasive frontal mucormycosis are documented in this article for the first time, which add a significant input to the existing medical literature.

While computed tomography (CT) imaging is commonly used to evaluate canine nasal tumors, the ability to differentiate tumor types based on imaging features remains limited. This retrospective study examined dogs with confirmed nasal neoplasia to determine whether CT characteristics differ between epithelial and mesenchymal tumors. Cases from a single institution (2013-2022) were reviewed, and the frequency of CT features between epithelial and mesenchymal tumors was compared using Fisher's exact test. Also, CT features of less commonly reported nasal neoplasms, including squamous cell carcinomas, polyps, and osteosarcomas, were described. Sixty-seven dogs with nasal neoplasia were identified; 48 (72%) had a type of epithelial neoplasia, and 19 (28%) had mesenchymal neoplasia. Dogs with epithelial neoplasia were more likely to show intracranial mass extension (p=0.04; OR 5.1; 95% CI 1.1-23.9), cribriform plate lysis (p=0.03; OR 4.5; 95% CI 1.2-15.8), lysis of ipsilateral sphenoid sinus (p<0.0001; OR 18.7; 95% CI 3.9-85.9), mass extension into ipsilateral sphenoid sinus (p=0.01; OR 5.8; 95% CI 1.6-20.2), and frontal sinus fluid (p=0.05; OR 4.7; 95% CI 1.3-16.2) than dogs with mesenchymal neoplasia. Dogs with mesenchymal neoplasia were more likely to show fluid in the ipsilateral maxillary recess (p=0.01; OR 5.3; 95% CI 1.4-18.6). Squamous cell carcinoma patients had two distinct presentation patterns: either a small nodule centered on the nasal planum with no associated lysis and mass extension, or a mass centered on and causing lysis of the maxillary or nasal bone. This investigation provides the first comprehensive comparison of CT characteristics between different canine nasal tumor types, offering potential prebiopsy diagnostic indicators.

ABSTRACTBackgroundAlthough extensive research has been conducted on paranasal sinuses across various human populations and animal species, studies focusing on dogs remain relatively scarce.PurposeThis study aimed to characterise the anatomical and morphometric structure of canine paranasal sinuses utilising computed tomography (CT) cross‐sectional imaging and three‐dimensional (3D) reformatted models.MethodsIn this study, CT images of 14 clinically normal dogs (7 females, 7 males) with a mean age of 6.2 ± 4.3 years were analysed. The localisation and boundaries of the paranasal sinuses, as well as the orientation and morphology of sinonasal openings, were identified through cross‐sectional imaging, whereas morphometric characteristics were evaluated using 3D models.ResultsDespite variations in shape among all examined animals, the paranasal sinuses bilaterally consisted of maxillary recess (MR) and frontal sinus (FS) (rostral, medial and lateral). In one 4‐year‐old male, the rostral FS was absent. The MR exhibited a volume of 4 cm3 and a surface area of 26 cm2. The lateral FS was the largest, accounting for 90% of total sinus volume and 78% of total surface area in both sexes, whereas the medial FS was the smallest, with respective ratios of 3% and 8%. The MR was identified as the most symmetrically positioned sinus, whereas the medial FS displayed the highest degree of asymmetry. In females, the right lateral FS had a significantly larger surface area than the left. No correlation was found between age and sinus morphometry.ConclusionAlthough this study was conducted on animals of certain age and sex, without considering breed‐specific characteristics, the findings contribute to a more detailed understanding of the cross‐sectional and reconstructive anatomy of the region. Moreover, these preliminary reference data may aid radiologists and clinicians in diagnosing sinonasal diseases.

Abstract Background Among the rare distal anterior cerebral artery (DACA) aneurysms, those lying below the genu of the corpus callosum are considered even rarer. While the conventional interhemispheric approach provides inadequate exposure to these aneurysms, the more popular basal approaches lead to frontal sinus violation with attendant risks. In addition, both these standard approaches are maximally invasive to the skin, bone and brain. Methods Three patients with sub-callosal DACA aneurysms were treated. A2 segment aneurysm was treated using a supra-orbital keyhole craniotomy, while the other two (distal, involving proximal A3 segment) were dealt with using pre-coronal unilateral keyhole parasagittal craniotomy and an anterior interhemispheric approach. The procedures were completed uneventfully. The clinical, radiological features and surgical videos were reviewed. Results The mean age was 47.3 years (37–53 years) with two females and one male. Two patients had acutely ruptured aneurysms, and all were in good clinical grades. One patient had an A2 segment aneurysm close to the anterior communicating artery, while the other two patients had a proximal A3 aneurysm, just beneath the genu of the corpus callosum. The aneurysm was completely occluded in all 3 patients. At follow-up (mean: 16.4 months), all 3 patients are functionally independent. Conclusion Subcallosal DACA aneurysms may be amenable to the keyhole approaches that spare the frontal sinus and the bridging veins. Case selection and experience with the traditional approaches are however, mandatory.

Introduction Frontal sinus surgery is among the most technically demanding areas in rhinology due to the complex anatomy of the frontal recess and proximity to critical structures such as the orbit and anterior cranial fossa. Although endoscopic sinus surgery (ESS) is the standard for most sinonasal pathologies, the frontal osteoplastic flap (OPF) remains important in select clinical scenarios. Objectives To evaluate the role of OPF in current rhinologic practice by presenting a retrospective case series and reviewing contemporary literature. Methods A retrospective analysis was conducted on 11 patients who underwent OPF between 2007 and 2019 at a Portuguese center. Surgical data, indications, approaches, and outcomes were reviewed. A literature review was also performed to contextualize findings. Results The most common indications were frontal sinus osteomas, mucoceles with orbital involvement, and refractory chronic frontal sinusitis. Supraciliary and bicoronal incisions were used, and in some cases, combined with ESS. No major complications occurred, and outcomes were highly satisfactory both functionally and esthetically. Conclusion Despite advancements in endoscopic techniques, OPF remains a valuable option for anatomically challenging, recurrent, or bone-involving frontal sinus disease. This case series and literature review support its continued role in the comprehensive surgical armamentarium in rhinology.