Q: Dr. Eppley, I had a frontal sinus obliteration with a bicoronal approach. Titanum plates and screws were used to secure a bone flap. Soon after all the hardware was show thru and I went through a second surgery to have it all removed. Now i found out the bone flap which was pretty large is resorped, which is no surprise as my forehead has a significant deep “thumbprint” and also other various irregularities. I am getting mixed opinions. Cement, no cement “It can be a nightmare” Iliac bone crest graft. Titanium mesh etc. Also my soft tissue is thinned out because a portion of the forehead tissue was used in the obliteration. Can you help me ?
A: It sounds like you had an osteoplastic frontal sinus procedure using a pericranial flap top cover the obliteration. I will assume that much of the frontal bone flap has resorbed, resulting in indentations and irregularities. I have seen this before and I don’t think it will be a ‘nightmare’. It will be scarred for sure and there may be some exposure into the residual frontal sinus areas. It rebuilding the brows and lower forehead, I would definitely use hydroxyapatite bone cement. (not acrylic/PMMA) bone cement. I would not use titanium mesh (as this will cause the same problems you had with previous hardware) or bone grafts. (they will largely resorb also) The thinning out of the overlying scalp and potential exposure to the frontal sinus makes it imperative that the most stable but biocompatible material be used.
Dr. Barry Eppley