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Published on: August 15, 2025
Image-guided frontal trephination: a minimally invasive approach for hard-to-reach frontal sinus disease
Mark A Zacharek1, Karen J Fong, Peter H Hwang
1Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health Systems, Detroit, MI, USA.
Objectives:
Peripherally located frontal sinus pathology may be unreachable with standard endoscopic techniques. Patients with superiorly or laterally based lesions often undergo osteoplastic flap with or without obliteration. Image-guided frontal trephination (IGFT) can localize pathology and provide excellent exposure. We present 13 patients in whom this technique was applied.
Study Design:
Medical records of 13 patients undergoing IGFT were retrospectively reviewed.
Results:
The patients' mean age was 49.2 years, (range 14-79); follow-up time was 29.9 months (range 12-39). Indications for IGFT were superiorly or laterally based mucoceles (3), fibrous dysplasia or osteoma (3), type 4 frontal cells (3), and frontal recess stenosis or ossification (4). In five patients, IGFT was combined with endoscopic transethmoid frontal sinusotomy; eight patients were treated through a trephination approach, and three patients underwent trephination with unilateral frontal sinus obliteration. One patient required revision; all others remain symptom free.
Conclusions/Significance:
IGFT offers an attractive alternative to osteoplastic flap.
