Rhino-frontal sinuseptotomy (RFS): a combined intra-extra nasal approach for the surgical treatment of severely diseased frontal sinuses.

OBJECTIVES: Frontal sinus surgery is a challenge to those involved in the treatment of recurrent frontal sinusitis. The purpose of this report is to describe the technique and to present the results of a combined endoscopic and external approach to the frontal sinus (rhino-frontal sinuseptotomy [RFS]).

MATERIAL: RFS was performed in 45 patients by the author; 41 of these patients had a follow-up over 12 months and were included in this series. Indications for RFS were severe chronic frontal sinusitis (n = 23), mucoceles (n = 12), in two cases each with osteoma, inverting papilloma, and malignant tumors of the frontal sinus, respectively. The surgical technique is started with an external approach according to Jansen-Ritter and includes the resection of the interfrontal septum, partial resection of the nasal septum, bilateral subtotal resection of the middle turbinates, bilateral endoscopic ethmoidectomy, and resection of the frontal sinus floor. The nasofrontal communication is epithelialized with free mucosal grafts and fixed with fibrin clue.

RESULTS: After a mean follow-up of 62 months, 40 patients (98%) had a widely patent epithelialized nasofrontal communication. Ninety-one percent of the patients with chronic frontal sinusitis or mucoceles noted complete relief of their frontal discomfort within 1 week after RFS. No patient required revision surgery of the nasofrontal outflow tract after RFS. Only one severe complication was recognized (cerebrospinal fluid leakage).

CONCLUSION: The results reported here with the RFS technique are superior to those reported on external procedures and endoscopic drill-out procedures. The key to successful management is the creation of a large nasofrontal communication, and direct epithelialization with free mucosal grafts obtained from the septum and turbinates.