Frontal sinus obliteration with hydroxyapatite cement

To evaluate the efficacy hydroxyapatite cement as an alternative to autologous fat in the obliteration of the frontal sinus after trauma or chronic suppuration.

Single institution, nonrandomized, prospective analysis of patients treated in an academic, tertiary care center. Patients were followed with physical examinations and were monitored for recurrent infections, which would have necessitated removal of the implant. Follow-up radiographs were obtained at 12 months. Standard surgical techniques were used to obliterate the frontal sinus with the addition of the placement of a vascularized pericardial flap along the frontal sinus floor.

Eleven patients underwent hydroxyapatite frontal sinus obliteration. There were 2 women and 9 men in the series with age ranges from 33 to 82 years (mean, 48 y). Three patients underwent obliteration for trauma and 8 for chronic infections with or without mucopyocele. The mean follow-up is 27 months (range, 3.3-37 mo). No patient has developed clinical or radiographic evidence of recurrent frontal sinusitis and at this point no implants have been removed. Nine of 11 patients (91%) report complete resolution of all symptoms.

Hydroxyapatite cement had demonstrated efficacy in full-thickness reconstruction of frontal sinus defects. The pericranial flap may provide a barrier to prevent infection of the implant in the face of acute ethmoid sinusitis. Hydroxyapatite cement offers the advantages of no donor site morbidity and the potential for complete osseointegration.