MANAGEMENT OF LOCALLY AGGRESSIVE SINUS DISEASE USING CRANIOFACIAL EXPOSURE AND THE GALEAL FRONTALIS FASCIA-MUSCLE FLAP

Histologically, benign sinus diseases can behave aggressively, potenti ally causing sight- and life-threatening conditions requiring surgical treatment. Four patients illustrating acute and chronic infection, si ngle and multiple sinus polyposis, and mucoceles are presented and dis cussed to illustrate how the principles of craniofacial exposure, rese ction, and reconstruction may be employed to treat aggressive sinus di sease. The bicoronal and buccal sulcus approaches minimize visible sca rring; wide exposure of the orbital contents and dura reduce the risk of excessive bleeding, neurologic complications, and orbital volume de rangements. Immediate cranial bone grafting and the well-vascularized galeal-frontalis myofascial flap obliterate the dead space and isolate the extradural space from contaminated facial cavities, diminishing t he risk of infection. The craniofacial surgical approach is particular ly appropriate for the management of aggressive frontoethmoidal and mu ltiple sinus involvement because it allows the treatment of sinus cavi ties under direct vision and complete resection of sinus disease.