Definitive Treatment of Persistent Frontal Sinus Infections: Elimination of Dead Space and Sinonasal Communication

Abstract

Radical débridement, meticulous removal of the tenacious sinus mucosa, and reconstruction with a free fibular flap in a single stage is a superb choice for eliminating persistent infectious complications associated with frontal sinus fractures in patients who have failed conventional management. The fibular flap provides a secure horizontal buttress, seals the nasofrontal outflow tract with vascularized muscle, and obliterates dead space.

Frontal Sinus Obliteration with Iliac Crest Bone Grafts. Review of 8 Cases

“…Rodriguez, et al, have proposed a vascularized bone graft obliteration for infected sinuses with a one stage reconstruction and have encouraging results. 3,4 The success of sinus obliteration is entirely dependent on meticulous removal of the sinus mucosa and obliteration of the drainage system and the frontal sinus cavity. 1 Characteristically, non-vascularized bone grafts are used in the initial treatment of frontal sinus fractures.…”

“…Thus, treatment is directed to prevent infectious complications and esthetic deformity of the frontal area and upper facial third. [1][2][3][4] The goals of treatment of frontal sinus fractures are well established: isolation of intracranial contents, correction of cerebral spine fluid leakage, prevention of infection and sequelae, restoration of functional integrity of involved structures whenever possible and restoration of facial contour and esthetics. 4,5 Presently, several articles describe reconstruction of frontal sinus fractures in cases where the sinus would traditionally be obliterated or cranialized.…”

The Fusion of Craniofacial Reconstruction and Microsurgery

“…31 Free tissue transfer is indicated when there is persistent osteomyelitis and chronic infection from an occluded nasofrontal duct. 31 The fibula free flap is the ideal choice for treatment of the infected frontal sinus, as it is a well-vascularized source of both bone and soft tissue. If additional soft tissue is needed, it can be used as a chimeric or compound flap with soleus muscle (Fig.…”

“…[22][23][24][25][26][27][28][29] Fat, muscle, and bone have been used to obliterate the sinus, and autologous tissues are preferred over prosthetic materials. 30,31 The goals of frontal sinus reconstruction include obliteration of the frontal sinus, reconstruction of the frontal bandeau, and restoration of forehead cosmesis. 31 Free tissue transfer is indicated when there is persistent osteomyelitis and chronic infection from an occluded nasofrontal duct.…”

“…30,31 The goals of frontal sinus reconstruction include obliteration of the frontal sinus, reconstruction of the frontal bandeau, and restoration of forehead cosmesis. 31 Free tissue transfer is indicated when there is persistent osteomyelitis and chronic infection from an occluded nasofrontal duct. 31 The fibula free flap is the ideal choice for treatment of the infected frontal sinus, as it is a well-vascularized source of both bone and soft tissue.…”