Image-guided frontal trephination: A minimally invasive approach for hard-to-reach frontal sinus disease

OBJECTIVES: Peripherally located frontal sinus pathology may be unreachable with standard endoscopic techniques. Patients with superiorly or laterally based lesions often undergo osteoplastic flap with or without obliteration. Image-guided frontal trephination (IGFT) can localize pathology and provide excellent exposure. We present 13 patients in whom this technique was applied. STUDY DESIGN: Medical records of 13 patients undergoing IGFT were retrospectively reviewed. RESULTS: The patients' mean age was 49.2 years, (range 1479); follow-up time was 29.9 months (range 12-39). Indications for IGFT were superiorly or laterally based mucoceles (3), fibrous dysplasia or osteoma (3), type 4 frontal cells (3), and frontal recess stenosis or ossification (4). In five patients, IGFT was combined with endoscopic transethmoid frontal sinusotomy; eight patients were treated through a trephination approach, and three patients underwent trephination with unilateral frontal sinus obliteration. One patient required revision; all others remain symptom free. CONCLUSIONS/SIGNIFICANCE: IGFT offers an attractive alternative to osteoplastic flap. (C) 2006 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.