8/1/13 Trephination of frontal sinus – ENT SCHOLAR entscholar.com/article/trephination-of-frontal-sinus/ 1/4 Trephination of frontal sinus August 1, 2013 · Rhinology Trephination of frontal sinus was practiced since prehistoric times. This article reviews this procedure. This procedure is still relevant even in the current nasal endoscopy era. This procedure should be learnt and practiced by all otolaryngologists as this could provide instant relief in acute frontal sinus infections. Introduction: Trephination of frontal sinus is a surgical procedure where in a small opening is made in the floor of frontal sinus facilitating drainage of its contents. Trephination of frontal sinus is nothing new. It dates back to prehistoric times. Two Peruvian skulls at the Museum of Man in San Diego show evidence of frontal trephination . Frontal sinus surgery was first described in medical literature in 1750. In fact that era was christened as “Era of Trephination”. In 1884 Alexander Ogstun described a trephination procedure where an opening was made in the anterior table of frontal sinus to evacuate pus. He also dilated the nasofrontal duct and curetted its mucosa. He believed that this procedure could facilitate better drainage of frontal sinus cavity. He also advocated placement of drainage tube inside the nasofrontal duct to prevent stenosis. Approximately about the same time Luc described a similar procedure, and hence this procedure came to be known as Ogstun Luc procedure. This procedure had a high incidence of failure because of increased incidence of nasofrontal stenosis. The first scientific description of Frontal sinus trephination was by Runge in 1750 . This procedure was advocated initially to purge the frontal sinus off its infected contents, thereby helping the frontal sinus mucosa to cleanse itself. Currently Functional endoscopic sinus surgery has replaced this surgical modality in the management of sinusitis. Since drainage of frontal sinus is dependent in nature it was ais proved assumed that creating an opening in the floor of the sinus would help in facilitating dependent drainage of the sinus. Frontal sinus surgery still remains a challenge even this day because of complex and highly variable anatomy of the drainage pathway. The proximity of cribriform plate medially, orbit laterally and anterior ethmoidal artery posteriorly adds to the stress while operating in this region. Indications of frontal sinus trephining: 1. Acute sinusitis not reponding to medical management 2. To identify frontal sinus opening in difficult cases intranasally during endoscopic sinus surgery. This can be performed by flushing flurescein dye and endoscopically visualizing its flow into the nasal cavity. This is one reliable way of identifying frontal sinus outflow tract . 3. To prevent stenosis of frontal sinus infundibulum after endoscopic sinus surgery. This can be achieved by passing a catheter down into the frontal recess. It can also be used to stent the frontal recess area after completing endoscopic frontal sinusotomy. Abstract 1 2 3 4 56 Author Professor Balasubramanian Thiagarajan Balasubramanian Thiagarajan