The place of Riedel's procedure in contemporary sinus surgery

Many operative procedures have been described to treat frontal sinus disease with varying results. Obliteration of the frontal sinus is attempted when drainage procedures fail. Most large series of patients undergoing sinus obliteration have reported recurrent disease yet the management of these patients is rarely discussed. We believe Riedel's procedure has an important role in the management of these patients. Riedel's procedure can help eradicate frontal sinus disease and symptoms when drainage and obliteration have failed and where there is persistent disease involving the anterior wall of the frontal sinus or the sinus itself. Whilst cranialization has a role in the removal of the mucosa or contents of the frontal sinus in craniofacial resection, the morbidity associated with it make Riedel's procedure preferable for dealing with chronic infection or locally invasive disease. Riedel's procedure also maintains a barrier in the form of the posterior wall of the frontal sinus and the intracranial contents. Post-operative disfigurement, the main criticism of this procedure, can be reduced to some extent by chamfering the margins of the frontal sinus along with the supraorbital rims and reconstructing the anterior wall at a later date if necessary. The authors are aware that any report about frontal sinus surgery should be judged after several years follow-up, and whilst not all these cases have been asymptomatic for a decade, several have been reviewed for many years.