Presented at the Middle and Western Section Meeting of the Triological Society, San Diego, California, U.S.A., February 2006.
Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection†
Version of Record online: 2 JAN 2009
Copyright © 2006 The Triological Society
Volume 116, Issue 9, pages 1585–1588, September 2006
How to Cite
Donath, A. and Sindwani, R. (2006), Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection. The Laryngoscope, 116: 1585–1588. doi: 10.1097/01.mlg.0000232514.31101.39
- Issue online: 2 JAN 2009
- Version of Record online: 2 JAN 2009
- Manuscript Accepted: 31 MAY 2006
- Pericranial flap;
- frontal sinus cranialization;
- frontal sinus fractures
Objectives: Extensive fractures involving the anterior and posterior tables of the frontal sinus are treated by frontal sinus cranialization. During this procedure, the disrupted posterior wall of the frontal sinus is removed, the sinus mucosa is drilled away, and the brain and dura are permitted to rest against the repaired anterior wall and sinus floor. Conventionally, the area originally occupied by the frontal sinus is left as dead space or filled with free adipose tissue. We describe a method of cranialization using a pericranial flap and report our experience with this technique.
Study Design: Retrospective study.
Methods: The medical records of patients who underwent frontal sinus cranialization using the pericranial flap at our institution were reviewed. Demographics, indications for cranialization, complications, and perioperative outcomes were examined.
Results: A total of 19 patients underwent (bilateral) frontal sinus cranialization with the pericranial flap between 2000 and 2005. Indications included extensive frontal sinus fractures involving the posterior table (78.9%), mucocele (10.5%), arteriovenous malformation (5.3%), and frontal bone osteomyelitis (5.3%). There were no intraoperative complications. A postoperative cerebrospinal fluid leak occurred in one patient with extensive skull base injuries. This was repaired endoscopically. Follow-up ranged from 9 to 55 months.
Conclusions: The pericranial flap is easily harvested and versatile. Using this vascularized tissue during cranialization affords added protection by providing an extra barrier between the intracranial cavity and the frontal bone and sinonasal tract. This technique is inexpensive, safe, and effective and should be considered when cranialization of the frontal sinus is performed.