Frontal Sinus Surgery with Osteoplastic Flap

Osteoplastic frontal sinus surgery with or without fat obliteration is an extensive procedure performed most frequently on patients with refractory chronic sinusitis or mucocele. Bosley (17) reviewed the records of 100 patients and found that 15 patients had postoperative headache, 7 had an incomplete obliteration, and 3 of 7 had recurrent disease. Therefore headache can herald recurrent disease. No other complications such as permanent numbness were discussed. Zonis (18) reviewed 100 osteoplastic operations on the frontal sinus and found that the most common problem was persistent hypesthesia in the distribution of the supraorbital nerve.

Montgomery (19) reviewed a series of 250 patients and found that 47 patients (18%) had early complications. Abdominal wound complications—hematoma, seroma, or abscess—were related to the fat graft. Hematoma, seroma, or abscess also occurred in the frontal wound. Osteoplastic flap incisions were made outside the frontal sinus with exposed dura but no brain injury. Four dural exposures were found when the mucous membrane was stripped. Five dural lacerations occurred, two of which had to be repaired. Other complications included necrosis of the skin of the dorsum of the nose, anosmia, temporary ptosis, and temporary dysfunction of the frontalis muscle. After 8 years, 6% of 208 patients had persistent postoperative pain, and 1% had persistent neuralgia. These complications occurred most often with brow incisions, in which the supraorbital nerves usually are incised, as opposed to coronal incisions, in which the supraorbital nerves usually are preserved. Poor appearance of the incision scar occurred among fewer than 1% of patients. Six percent had depression or elevation of the osteoplastic flap. This complication can be avoided with bevelling of bone cuts and meticulous closure, with a drill hole and wiring if necessary. Only 6% of patients needed revision surgery (19).

Lawson and Reino (20) found that 10% of 102 patients with osteoplastic flap had embossment of the frontal bone flap. Six of the 12 patients needed surgery for repair. The best way to avoid this problem is to wire or manipulate the flap into position to prevent movement. Hypesthesia and wound infection are the most common complications after osteoplastic flap surgery. Postoperative pain persists among 6% of patients, and almost 7% have scarring or forehead abnormalities. Although exposure of dura does occur, CSF leak, meningitis, or brain injury is unusual. After operations on 43 patients, Ulualp, Carlson, and Toohill (21) found that 6 patient has decreased sensation and 1 had CSF leak.

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