Modified glabellar rhytid incision for frontal sinus trephination

Surgical management of the frontal sinus is more complex compared to the other sinuses. Testament to this fact is that for years the standard for refractory frontal disease has been the destructive procedure of an osteoplastic flap with complete obliteration of the sinus. With better understanding of the physiology of the paranasal sinuses, there has been a shift toward surgery directed at functionally improving drainage by widening the natural outflow pathway with purely endoscopic techniques. Whereas expanded frontal approaches such as the endoscopic modified Lothrop procedure (EMLP) can provide quite extensive access, they can be nicely augmented with a concomitant mini-trephination. In circumstances such as complicated acute frontal sinusitis, extensive lateral pneumatization of the frontal bone, or neo-osteogenesis of the frontal recess, a trephination continues to be a useful adjunct for both identifying the frontal sinus drainage pathway and delivering medication. Despite its benefits, the trephination approach still requires an external incision on the face, which, even in the best of hands, may not be aesthetically pleasing. The traditional trephination incision lies within the brow and can be noticeable particularly if there is local alopecia or other brow asymmetry. Given this, we have developed a modified approach to the frontal sinus trephination for chronic disease, utilizing glabellar rhytids when available. This has proven to be a useful adjunct and has resulted in significant benefit with respect to the aesthetic appearance of the face postoperatively. MATERIALS AND METHODS