Radiologic Evidence of Delayed Frontal Sinus Disease After Feminizing Frontal Cranioplasty

Area of Science:

• Plastic Surgery
• Otolaryngology
• Radiology

Background:

• Feminizing frontal cranioplasty (FFC) is a key procedure for upper facial feminization.
• This surgery often requires breaching the anterior table of the frontal sinus.
• Delayed frontal sinus complications after FFC are a concern, but long-term imaging data are lacking.

Purpose of the Study:

• To evaluate the long-term incidence of frontal sinus disease after feminizing frontal cranioplasty (FFC).
• To assess the safety of FFC concerning delayed complications of the frontal sinus.

Main Methods:

• A case series of adult transfeminine patients who underwent FFC between 2016 and 2019.
• Postoperative CT scans were compared with preoperative scans using the Lund-Mackay (LM) scoring system.
• Patients were assessed for frontal sinus disease, and charts were reviewed for sinusitis diagnoses.

Main Results:

• 40 patients were included, with CT scans performed an average of 71 months post-surgery.
• No significant difference was observed in overall or frontal sinus-specific LM scores pre- and post-surgery.
• While 12.5% showed minor mucosal thickening, no significant frontal sinus pathology (mucoceles, osteomyelitis, fistulas) was detected.

Conclusions:

• FFC appears to be a relatively safe procedure with a low risk of frontal sinus complications in the initial six years.
• Continued long-term surveillance is recommended to identify any potential delayed onset of serious frontal sinus pathology.