Traumatic Cerebrospinal Fluid Rhinorrhoea Treated by Frontal Sinus Osteoplasty

The author describes a new method of operation, used to date in 6 eases of traumatic cerebrospinal fluid rhinorrhoea with cranionasal fistula or fistulas in the region of the posterior wall of frontal sinus. The method involves an autogenous osteoplasty of one or both frontal sinuses. After a curved incision from the side of the upper nose along the underside of the eyebrow, a large aperture was drilled in the anterior wall of the frontal sinus. The mucous membrane of the frontal sinus was removed carefully under visual control. The nasofrontal duct was closed with a plug of bone which, like all bone tissue used in the operation, was taken from the iliac crest. A plate of spongiosa was placed across the fistula and the exposed dura, and the whole sinus filled with spongiosa. A lid of cortical bone was placed in the large aperture in the anterior wall of the frontal sinus. If necessary, the operation can be bilateral. The cerebrospinal fluid leak in all 6 cases ceased with the operation.