Complicated frontal sinusitis: evaluation and management.

The diagnosis and management of complicated cases of frontal sinusitis are challenging problems. Unacceptable mortality and morbidity from delay in diagnosis and treatment must be weighed against the early performance of deforming surgical procedures. Many of these patients require prolonged hospitalization for intravenous antibiotic therapy. The assessment of the optimal time course for such therapy has been difficult. Six illustrative cases of frontal sinusitis, complicated by intracranial suppuration, osteomyelitis, and/or bone erosion, are presented. The use of CT, bone, and gallium scans in the diagnosis of complications--and in the timing of antibiotic therapy and surgical intervention--are discussed. Guidelines are formulated for the evaluation and treatment of complicated frontal sinusitis.