Persistent Forehead Sinus After Traditional Cautery: Frontal Mucocele Complicated by a Fronto-Mucocutaneous Fistula

Frontal mucocutaneous fistula is a rare complication of chronic frontal sinus disease and may remain unrecognized because of its slow, insidious progression. This case report presents the clinical course, diagnostic process, and surgical management of this uncommon condition. A 56-year-old Ethiopian woman presented with a 5-year history of frontal swelling, nasal obstruction, and headache. Following cautery by a traditional healer, she developed a persistent draining sinus over the right frontal region. Examination revealed a mucocutaneous fistula discharging seropurulent fluid, while laboratory studies and nasal endoscopy were unremarkable. Computed tomography (CT) demonstrated frontal sinus opacification with bony erosion consistent with a frontal mucocele complicated by fistula formation. The patient underwent external osteoplastic frontal sinusotomy with complete mucosal excision and sinus obliteration using an autologous abdominal fat graft. Postoperative recovery was uneventful, with immediate cessation of fistula drainage and complete symptom resolution. At 1-week follow-up, the incision had healed well with no complications. This case emphasizes the need for high clinical suspicion when evaluating chronic frontal swelling, the essential role of CT imaging in detecting sinus pathology and bony defects, and the effectiveness of surgical obliteration in achieving durable cure and preventing potentially serious intracranial sequelae.