Frontal sinus obliteration: in search of the ideal autogenous material.

The controversies concerning obliteration of the frontal sinus in response to trauma, infection, or tumor growth are long-standing (1913 to the present) and related to the field of training of the surgeon. Successful frontal sinus obliteration requires (1) meticulous removal of the frontal sinus mucosa, (2) removal of the inner cortex of the sinus wall, and (3) permanent occlusion of the nasofrontal duct. It is significant to note that most of the clinical literature relates to management of infected sinuses (sinusitis) and most experimental studies are done on uninfected, unfractured feline models. Therefore, no direct reference can be made to the management of the fractured frontal sinus. The techniques in current use are autologous implantation of fat, bone, and muscle, along with the technique of spontaneous osteogenesis. These techniques are all effective when the preceding guidelines are followed, with the only real advantage being that the spontaneous osteogenesis avoids the problem of donor-site morbidity, which has been as high as 5 percent. This factor makes the osteogenesis technique the method of choice for frontal sinus obliteration. This literature review provides the surgeon with the objective data available for optimal frontal sinus obliteration.