Superiorly based osteoplastic flap for frontal sinus disease

The osteoplastic flap is a widely used technique as an approach to frontal sinus disease. All current textbooks describe the technique with basing the flap inferiorly along the orbital rim and across the naso-frontal suture line. Since 1977, we have had occasion to base the flap superiorly in eight cases with good results. We feel that the superiorly based flap is ideally indicated in unilateral disease, particularly in the balding male, where a coronal incision would be very obvious. It is also a more direct approach. The skin incision itself can be parallel to the brow or almost identical to a blepharoplasty incision. After the floor of the frontal sinus has been removed (as in a Lynch or Howarth approach), cuts in the anterior wall of the frontal sinus are made under direct vision, and the bone is fractured at the superior extent of the sinus. This is certainly quicker and simpler than the standard approach, where a template is required. The risks of CSF leak are greatly diminished. The surgeon has the option of obliterating the sinus, removing the intersinus septum, or creating a mucoperiosteal flap. Details of the technique and two illustrative cases are presented.