An Endoscopic Approach for Frontal Sinus Cutaneous Fistula With Completely Ossified Frontal Recess

Abstract

A frontal sinus cutaneous fistula (FSCF) is a rare and challenging condition. Remarkable advancements in endonasal endoscopic surgery (EES) have enabled the treatment paradigm for a FSCF to gradually shift from open procedures to ESS. Nevertheless, the experience of EES for a post-trephination-related FSCF is rare, especially in patients with a pronounced frontal recess (FR) ossification. Here, we report an endoscopic strategy for successfully treating a post-trephination-related FSCF with complete ipsilateral FR neo-osteogenesis. Through two surgical corridors created by the modified mini-Lothrop procedure and an ipsilateral frontal osteotomy window, we established a patent drainage pathway from the affected side to the opposite side. This strategy may prevent potential orbital and cranial base injuries from affecting the ossified region of the ipsilateral FR. Moreover, in addition to the advantage of aesthetic outcomes, the procedure allows a single-stage surgery and facilitates the debridement and surveillance of the wound through the drainage pathway postoperatively. In conclusion, this technique could be a feasible endoscopic strategy for a FSCF, regardless of the severity of the FR ossification.