Osteoplastic Flap Approach for Removal of a Large Frontal Sinus Osteoma

Edited by Qasim Husain MD

Indications:

• Access to large osteomas of the frontal sinus
• Excision of frontal inverted papillomas or other neoplasms
• Chronic frontal sinusitis after failed frontal dillout (Draf 3) procedure
• Frontal CSF leak or mucocele which cannot be accessed endoscopically

Highlights:

• Bicoronal or brow incision
• Elevation of scalp flap in sub-galeal plane
• Outlining sinus perimeter with image-guidance or x-ray template
• Saw and chisels to incise and elevate osteoplastic flap

Keep in mind:

• Bony cuts along sinus perimeter should be beveled inward
• If sinus is to be obliterated with fat, the nasofrontal ducts should be obliterated with Surgicel, the sinus mucosa should be completely removed, and the entire bony sinus interior should be drilled.