Pneumosinus Dilatans: Rare Cause of Slowly Changing Frontal Contours

Frontal pneumosinus dilatans is a rare entity that is documented only by a few reports. It is an abnormal expansion of the aerated frontal sinus, with sinus walls of normal thickness. The expansion of the bone may be generalized or focal. It is not only an aesthetic problem but may also have functional consequences. We herein present the case of a 23-year-old woman who had been referred to the maxillofacial and plastic unit in Sousse (Tunisia) complaining of a prominence on her right supraorbital region and forehead. The cause was unknown and there were no functional problems. Computed tomography showed a large pneumatized frontal sinus and confirmed the resulting bony prominence. The patient was taken to the operating room, where the frontal and supraorbital regions were exposed through a bicoronal incision. The anterior wall of the right frontal sinus was removed, and was divided into segments that were then fixed in the desired position using a titanium mesh plate. Excellent results were obtained, and the patient had no complaints and was satisfied with her appearance. She remained well two years postoperatively. Pneumosinus dilatans is an entity every plastic surgeon should be aware of because its treatment falls within the realm of craniofacial surgery. The etiology remains unclear, and surgical management is directed toward surgical exploration of the sinus to ensure recontouring of the anterior table of the frontal sinus to correct any cosmetic deformity. Several authors have published different surgical techniques.