Efficacy and Safety of Frontal Sinus Cranialization

Objective: To compare the efficacy and safety of frontal sinus cranialization to that of obliteration after extirpation of benign lesions of the frontal sinus.

Study Design: A retrospective case series with chart review was conducted.

Methods: Between 1994 and 2011, 69 patients underwent open excision of benign frontal sinus pathology and reconstruction by either frontal obliteration (n = 41, 59%) or frontal cranialization (n = 28, 41%). The incidences of postsurgical complications, such as skin infections, cerebrospinal fluid (CSF) leak, meningitis, and pneumocephalus, were compiled, as was the need for sequential surgical procedures following secondary mucocele formation due to reconstruction failure.

Results: Pathologies included osteoma (n = 34, 49%), mucocele (n = 27, 39%), fibrous dysplasia (n = 6, 9%), and encephalocele (n = 2, 3%). Complications included local infections (n = 6), postoperative cutaneous fistula (n = 1), telecanthus (n = 4), diplopia (n = 3), nasal deformity (n = 2), and epiphora (n = 1). No patients suffered postoperative CSF leak, meningitis, or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision reconstruction for postoperative mucocele. One revision was a sequential obliteration, and the obliteration had been converged to cranialization of the frontal sinus in the other five cases. Cranialization of the frontal sinus was significantly superior to obliteration (P = .037, Fisher's exact test) for preventing secondary mucoceles.

Conclusion: Cranialization of the frontal sinus is a safe procedure that provides definitive reconstruction after excision of benign lesions via open approach, and it is superior to frontal sinus obliteration.