Dr Ramadan has been presented with an extremely controversial subject, the surgical treatment of chronic inflammatory frontal sinus disease. Specifically, he has been asked to justify the hypothesis that "the ideal treatment of symptomatic chronic frontal sinusitis is an osteoplastic flap with fat obliteration."
Joseph B. Jacobs, MD
In my opinion there is no single surgical approach for chronic inflammatory frontal sinusitis that consistently will lead to relief of symptoms, eradication of disease, preservation of function, and a minimum of deformity. As technology continues to improve, endoscopic techniques will be increasingly appropriate for reestablishment of nasofrontal duct (NFD) ventilation and drainage in chronic inflammatory frontal sinusitis. This includes dysfunction due to a mucocele extending toward the NFD, inflammatory mucosal disease, or anatomic obstruction within the NFD. Depending on the experience of the surgeon, external frontoethmoidectomy (Lynch) with or without NFD reconstruction is acceptable both as a primary surgical procedure and following failed endoscopic techniques. Recently, Amble et al1 published comparative results of Lynch and osteoplastic procedures demonstrating good long-term results with NFD reconstruction as well as osteoplastic surgery.