Traumatic Cranionasal Fistulas Persistent Cerebrospinal Fluid Rhinorrhoea and their Repair with Frontal Sinus Osteoplasty

The incidence of skull injuries has continuously increased in recent years and may be expected to go on increasing in the future. Road accidents frequently produce frontobasal skull fractures. Cerebrospinal fluid rhinorrhoea is a serious complication in these frontobasal skull fractures. The condition is discussed in the first section of the paper. It is pointed out that most of the cases of chronic cerebrospinal fluid rhinorrhoea show the cranionasal fistula in the posterior wall of the frontal sinus. The reasons for this are also discussed. An extracranial operative method for their treatment is described. This method was used in 13 chronic cases of cerebrospinal fluid rhinorrhoea, and proved successful in all of them. The method involves frontal sinus osteoplasty through a curved incision from the back of the nose to the underside of the eyebrow with an auxiliary incision up toward the forehead. The anterior wall of the frontal sinus is removed by drilling, and the mucosa of the frontal sinus is meticulously removed. The nasofrontal duct is hermetically sealed with a peg of bone taken from the iliac crest. A plate of spongiosa is placed across the craniosinus fistula, and the whole frontal sinus is filled with spongiosa. The anterior wall of the frontal sinus is reconstructed with mosaic plastics of cortical bone. The incision is closed without drainage and dressed with a compression bandage.