Surgical Treatment for Frontal Sinus Complications after ...



Surgical Treatment for Frontal Sinusitis after Craniotomy

Nobutaka Yoshioka,MD　Michiaki Hiramoto,MD Haruo Ogawa,MD

Hiroko Nakatani,MD　

INTRODUCTION: It is well known that frontal sinusitis sometimes develops after trauma and craniotomy with frontal sinus injuries. It is controversial that the affected frontal air sinus should be cranialized, obliterated or preserved (1-3). The purpose of this study is to evaluate our sinus preservation method for frontal sinusitis after craniotomy.

MATERIALS & METHODS: From 1998 to 2006, we treated ten cases of frontal sinus complications which have developed more than one month after craniotomy at which frontal sinus was involved. An initial finding of every case was forehead skin fistula with purulent discharge (Figure1). Infection developed more than 1 year after craniotomy in seven cases. And in the other cases infection developed a few months after craniotomy. At first surgery, debridement and sinus preservation with frontalis-pericranial flap was performed (Figure2). Pneumatized frontal sinus was confirmed by CT scan after first surgery. At second surgery, cranioplasty with hydroxyapatite ceramic implant was performed (Figure3-5). Mean follow-up range was 42 months (range: 4 to 84 months).

RESULTS: Preoperative CT scan showed soft tissue density of affected frontal sinus in every case. Inflammation induced by bone wax seemed the main cause of frontal sinusitis in every case.　Eight cases showed uneventful postoperative course. Two cases showed recurrence of infection within a few months. In one of the two cases with recurrence of infection, the frontal sinus was obliterated with temporalis muscle flap. This case showed uneventful course after the frontal sinus obliteration. The other case with recurrence of infection was managed conservatively.

CONCLUSION: The results reported here with sinus preservation method for frontal sinusitis after craniotomy showed relatively good results. However, nasofrontal duct is likely to become narrow or obstructed spontaneously in the cases which have more than ten years interval between first craniotomy and infection. And we should select sinus obliteration or cranialization in such cases with recurrence of infection after sinus preservation method.

[pic] [pic]

Figure1.Preoperative view Figure2. Frontal sinus preservation

with forehead skin fistula. at first surgery.

[pic] [pic]

Figure3. Frontal sinus is not Figure4. Cranioplasty with

opened at second surgery. hydroxyapatite ceramic implant.

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Figure5. Postoperative view.

REFERENCES

1. Lannetti G, Cascone P, Valentini V, et al. Paranasal sinus mucochele: Diagnosis and treatment. J Craniofac Surg 8:391-398, 1997.

2. Richtsmeier WJ, Briggs RJS, Koch WM, et al. Complications and early outcome of anterior craniofacial resection. Arch Otolaryngol Head Neck Surg 118:913-917, 1992.

3. Cultrera F, Giuffrida M, Mancuso P. Delayed post-traumatic frontal sinus mucopyocoele presenting with meningitis. J Cranio-Maxillofac Surg 34:502-504, 2006.

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