The endoscopic management of chronic frontal sinusitis associated with frontal sinus posterior table erosion

Expansile inflammatory diseases of the frontal sinuses may produce erosion of the posterior table of the frontal sinus. In these instances, the bone b etween sinus mucosa and intracranial dura is absent. Over the past decade, endoscopic frontal sinusotomy has emerged as the preferred technique for th e treatment of refractory chronic frontal sinusitis. Endoscopic approaches also have a role in the most advanced instances of frontal sinusitis. A ret rospective chart review of patients who were treated for frontal sinusitis with erosion of the frontal sinus posterior table was performed. Eight pati ents were identified. All patients underwent endoscopic frontal sinusotomy; some patients required multiple endoscopic procedures. Complete frontal re cess dissection with identification of the frontal ostium was achieved for all involved frontal sinuses. In all cases, this postoperative result was m onitored by CT scans (where indicated) and serial nasal endoscopy, which de monstrated good frontal sinus aeration and normal mucociliary clearance. An tibiotics were administered for culture-documented bacterial exacerbations, and systemic steroids were given for management of allergic fungal sinusit is and sinonasal polyposis associated with asthma. No patient underwent fro ntal sinus obliteration or cranialization. No suppurative intracranial comp lications were noted during the postoperative period. Endoscopic frontal si nusotomy can be used safely for the definitive management of frontal sinusi tis associated with posterior table erosion. In fact, endoscopic techniques may represent the preferred approach for the treatment of this problem. Su ch an approach avoids the morbidity of more destructive alternatives (such as obliteration), and serves to create a frontal sinus with normal mucocili ary clearance.