The safety of frontal sinus fat obliteration when sinus walls are missing

The dilemma of the management of a severely fractured frontal sinus when portions of the walls are missing presents a number of therapeutic options. The safety of placing a fat graft in such a sinus for obliteration when the graft will be required to obtain its nourishment from the scant vessels contained within the subcutaneous tissue or dura, or worse still, from a dural or bone graft is questioned. Clinical experience has suggested that such a procedure may not be safe. An experiment was performed in nine cats in which all of either the anterior or posterior frontal sinus wall was removed in eight sinuses, and 50% of either wall in the remaining ten. A standard osteoplastic flap and fat obliteration technique was then done. On microscopic examination 3 months later, 50% of the sinuses showed either reepithelialization, mucocele formation, infection, or some combination. This gives some support to the contention that patients undergoing fat obliteration after fracture in which frontal sinus walls are missing are in jeopardy of subsequent mucocele formation and infection.