Recreating the microscopic direct access Draf 2a frontal sinusotomy in the endoscopic era and comparison to an angled instrument approach.

PURPOSE: Microscopic Draf 2a frontal sinusotomy relied on direct access. However, the modern-day endoscopic approach is hindered by the anterior-posterior dimensions of the frontal recess. The nasofrontal beak, angled endoscopes, and variable frontal recess anatomy make the surgery challenging. Carolyn's window frontal sinusotomy removes the limitation of anterior-posterior dimensions and is an endoscopic version of the microscopic Draf 2a. This study aims to compare the perioperative outcomes and morbidity from endoscopic direct access Draf 2a compared to angled access Draf 2a. METHODS: Consecutive adult patients (> 18 years) seen at a tertiary referral clinic who underwent Draf 2a frontal sinus surgery using either endoscopic direct access (Carolyn's window) or endoscopic angled instrumentation were included. Patients who underwent Carolyn's window were compared to those with angled Draf 2a frontal sinusotomy. RESULTS: One hundred patients (age 51.96 ± 15.85 years, 48.0% female, follow-up 60.75 ± 17.34 months) were included. 44% of patients used Carolyn's window approach. 100% [95% CI 98.2-100%] of patients achieved successful frontal sinus patency. Both groups were comparable for early morbidities (bleeding, pain, crusting, and adhesions) and late morbidities (retained frontal recess partitions). There were no other morbidities in the early and late postoperative periods. CONCLUSION: The endoscopic direct access Draf 2a, or Carolyn's window, removes the anteroposterior diameter limitation. The frontal sinus patency and early and late surgical morbidities of direct access Draf 2a were comparable with the angled Draf 2a frontal sinusotomy. Surgical modifications, often with drills and bone removal, can be successfully made to enhance access in endoscopic sinus surgery without concern for additional morbidity.

[History of frontal sinus surgery and current view of the problem. Part 1]. / Istoriya khirurgii lobnoi pazukhi i sovremennyi vzglyad na problemu. Chast' 1.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

[History of frontal sinus surgery and current view of the problem. Part 2]. / Istoriya khirurgii lobnoi pazukhi i sovremennyi vzglyad na problemu. Chast' 2.

Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.

Orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis.

BACKGROUND: We report a rare case of orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis. Common concerns involving the orbital subperiosteal space include abscess, hematoma and tumor. CASE PRESENTATION: A patient presented to our clinic with periorbital swelling and limited extraocular muscle movement in her left eye. Computed tomography revealed a superior subperiosteal mass with frontal and ethmoidal sinusitis. We diagnosed the patient with subperiosteal hematoma and surgical evacuation was performed via superior orbitotomy. Brown serous discharge was drained and biopsy demonstrated fibrin clots. The final diagnosis was orbital subperiosteal hematoma and the patient was discharged with symptoms resolved. CONCLUSION: Orbital subperiosteal hematoma is difficult to distinguish from abscess owing to its rarity and similar presentation. Computed tomography is helpful in diagnosis, and surgical evacuation during the early stages is essential to achieving a good outcome.

Assessment of the necessity of frontal sinostomy in cases of frontal sinusitis associated with fungus ball of the maxillary sinus.

PURPOSE: This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone. METHODS: This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. RESULTS: In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up. CONCLUSION: These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

[The efficacy of the extended endoscopic frontal sinus drill-out in cases of repeatedly operated polypous-purulent pansinusitis accompanied by a whistle in the front wall of the frontal sinus]. / Effektivnost' rasshirennoi endonazal'noi endoskopicheskoi frontotomii pri mnogokratno operirovannom khronicheskom polipozno-gnoinom pansinusite, oslozhnennom formirovaniem svishcha perednei stenki lobnoi pazukhi.

Treatment of patients with severe chronic and recurrent forms of frontal sinusitis, often caused by scarring as a result of repeated interventions in the frontal sinuses, is a difficult task. In such cases, for adequate drainage of the frontal sinus and ensuring stable patency of the nasolabial anastomosis, an endoscopic extended frontotomy can be the choice operation, the possibility of which certainly depends on the experience of the surgeon, anatomical features of the structure of the frontal sinus and the nature of the pathological process. The article shows the effectiveness of surgical treatment of chronic purulent frontal sinusitis that developed after 5 interventions on the paranasal sinuses with external and combined access, accompanied by the development of a fistulous passage of the anterior wall of the frontal sinus. For wide drainage of the frontal sinus and stable preservation of patency of the nasolabial fistula, the patient underwent extended endoscopic frontotomy (Draf III operation according to the international classification).

Draf III frontal sinus surgery for the treatment of Pott's puffy tumour in adults: our case series and a review of frontal sinus anatomy risk factors.

PURPOSE: We present our case series of four adult patients with Pott's puffy tumour (PPT), successfully treated with Draf III over a mean period of 11 months. A critical review of the literature is also provided. METHODS: A retrospective review of patients undergoing Draf III for PPT from January 2018 to January 2019 was performed. RESULTS: Four consecutive male patients ranging from 26 to 62 years, with a mean age of 49.5 ± 16.3 years, undergoing Draf III for Pott's puffy tumour were included. Two patients had a Kuhn type IV frontal cell narrowing the frontonasal pathway and presented without previous sinus surgery, whereas the other two had previous sinus surgery. The success rate of the operation was 100% with an average length of follow-up of 11 months (range 5-18). CONCLUSION: In our experience, the Draf III procedure is a highly effective treatment of PPT. In particular, we have demonstrated it to be very effective in accessing highly positioned Kuhn type IV cells.

The Variants of Frontal Recess and Its Effect in the Development and Prevalence of Frontal Sinusitis in Patients in a Tertiary Care Hospital: A Retrospective Observational Study.

According to medical literature, the frontal recess' intricate physical structure resembles an inverted funnel. The anatomical structure is not distant from the frontal ostium. Surgery requires a good understanding of the frontal recess architecture because of the intricate anatomy of this relatively small area. The pathophysiological characteristics of frontal sinusitis and the process of sinus ventilation through the sinus ostium have been linked, according to medical literature. Medical studies show that one of the most important factors affecting the amount of drainage in the frontal sinuses is the size of the frontal sinus ostium. Inflammation brought on by frontal recess cells can frequently affect the airflow in the frontal sinuses. The drainage channel of the frontal sinus is stated as narrowing in the current investigation as an observed phenomenon. The aim of this study was to examine the frontal recess changes and how they might affect the emergence of frontal sinusitis. The classification of frontal recesses according to their various categories was the study's principal finding. The investigation of the causal elements that resulted in the development of frontal sinusitis was the study's secondary goal. In a hospital setting, a cohort of 200 patients with sinonasal disorders underwent a retrospective observational research. Over the course of a year, from July 2021 to June 2022, the study participants had evaluations at a tertiary care center. 200 CT PNS images of individuals who fit certain inclusion and exclusion criteria were examined in this study. Using the chi-square test, the study looked into the relationships between several risk factors, including age, gender, and the type of frontal recess. The presence of frontal sinusitis served as the main outcome indicator. This study included a total of 200 participants with a mean age was 43.38 years (± 10.69). There was 146 (73%) male and 54 (27%) female were in the study. Type I frontal recess in 50 (25%), type II in 82 (41%), type III in 24 (12%) and type IV in 18 (9%) patients. The association of age (P = 0.141) and gender (P = 0.345) with frontal sinusitis was not significant. The statistical association between type of frontal recess and frontal sinusitis was statistically not significant. The association between age and the type of frontal recess was found to be statistically significant by Fischer's exact test with P value of 0.012 (< 0.05), whereas gender was not associated with the type of frontal recess by the same test. It is difficult to overstate the significance of the terms frontal recess, frontal sinusitis, and sinus ostium in this particular medical context. This article was a retrospective observational study that investigates the connection between frontal sinusitis and changes in the frontal recess in patients receiving care at tertiary medical facilities.

Dynamic radiologic changes in repeated barotraumatic frontal sinusitis: A CARE case report.

INTRODUCTION: Flight staff are at particular risk of iterative sinus barotrauma. We here report a case of barotraumatic atelectasic frontal sinusitis with dynamic radiologic change in frontal sinus volume. CASE REPORT: A 46-year-old air pilot was referred for right frontal pain occurring at each landing. Two sinus CT scans were taken: one after a period of intense flying and the other after a month without flying. In the right frontal sinus, a type-3 Kuhn cell changed in volume from 6×11×12mm to 13×18×19mm. The alteration involved a modification in the medial wall, which was demineralized and changed position within the frontal sinus. Removal during endoscopic frontal sinusotomy allowed complete resolution of pain. DISCUSSION: This article reports radiologic change in a frontal sinus wall in a setting of repeated barotraumatic frontal sinusitis with a dynamic atelectasic component. In iterative barotrauma, we advocate imaging at different time points. When the ostial obstruction is identified, functional aeration surgery can be applied.

Pott's puffy tumor: A rare complication of sinusitis. A case report. / El tumor inflamatorio de Pott: una complicación infrecuente de la sinusitis. Reporte de caso.

A rare complication of frontal sinusitis includes Pott's puffy tumor. It manifests as a swelling of the forehead due to the presence of a subperiosteal abscess secondary to osteomyelitis of the frontal bone. A timely diagnosis allows for an early, intensive medical and surgical treatment, which is critical to prevent serious intracranial complications. Here we describe the case of a 12-year-old boy with Pott's puffy tumor as a complication of pansinusitis. This case was a diagnostic challenge; however, a timely treatment allowed for a favorable clinical course.

Una complicación infrecuente de la sinusitis frontal es el tumor inflamatorio de Pott. Se manifiesta como una tumefacción en la frente por la presencia de un absceso subperióstico secundario a una osteomielitis del hueso frontal. El diagnóstico oportuno permite un tratamiento intensivo médico y quirúrgico precoz, esencial para evitar complicaciones intracraneales graves. Se presenta el caso de un varón de 12 años con un tumor inflamatorio de Pott como complicación de una pansinusitis. Representó un desafío diagnóstico; sin embargo, la instauración del tratamiento oportuno permitió una evolución clínica favorable.

Frontal Sinus Mucopyocele Presenting as a Painful Subcutaneous Forehead Mass in a Patient with Chronic Sinusitis.

Mucoceles of the paranasal sinuses are benign, expansile lesions that develop secondary to sinus ostia obstruction. Presenting signs and symptoms vary widely but frequently include frontal headache and swelling, as well as visual changes and globe displacement depending on orbital involvement in the case of frontal sinus mucoceles. Given the potential for orbital or intracranial involvement, urgent imaging with computed tomography (CT) is important for patients with symptoms concerning for a frontal sinus mucocele. Definitive treatment is surgical. In this article, we report a case of a 50-year-old male who presented to a primary care clinic with a painful forehead mass, found to have a frontal sinus mucocele with erosion through the frontal bone that was eventually treated surgically. We also summarize presenting signs and symptoms of frontal mucoceles reported in the literature as these are important for clinicians to be familiar with, considering the potential emergent complications.

A Case of Pott's Puffy Tumor in a Patient With Eosinophilic Chronic Rhinosinusitis.

Eosinophilic chronic rhinosinusitis (ECRS) is a refractory type 2 inflammation-based airway allergic disease that is prone to complications such as bronchial asthma. Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone accompanied by a subperiosteal abscess. A 56-year-old female with a history of cranial surgery and bronchial asthma presented to an otolaryngology clinic with nasal obstruction and loss of smell, later developing swelling and redness on her forehead. She was diagnosed and treated for ECRS and was thought to have developed PPT during her course. Nasal endoscopy reveals bilateral polyp formation originating from the middle meatus. Paranasal computed tomography (CT) indicates substantial swelling extending from the opening of the frontal sinus to the adjacent subcutaneous tissue, accompanied by a defect in the frontal bone and osteolysis at the base of the frontal skull. Her management included conservative antibiotic therapy adjusted due to a drug eruption and, subsequently, endoscopic sinus surgery (ESS). The case was complicated by the patient's medical history and the absence of detailed surgical records, which limited the use of enhanced imaging techniques. This underscores the complexity of diagnosing and managing PPT in adults, particularly those with prior surgeries, emphasizing the need for a tailored diagnostic and therapeutic approach that integrates detailed patient history with current clinical indicators to effectively guide treatment. This case contributes to the limited literature on adult PPT and underscores the critical need for careful patient monitoring and detailed surgical history.

Computed Tomographic Study of Frontal Sinus Cells and Opacification as Per the International Frontal Sinus Anatomy Classification.

INTRODUCTION: International frontal sinus anatomy classification (IFAC) was introduced in 2016 to standardize the nomenclature of the cells in the frontal recess region, facilitate better communication between surgeons and precision in surgical planning, and improve surgical teaching. This study aims to estimate the radiological prevalence of the different frontal recess cells according to the IFAC and to evaluate the relationship of these cells with the frontal sinus opacification in patients with chronic rhinosinusitis. METHODS: In this study, 90 participants diagnosed with chronic rhinosinusitis (CRS) who underwent computed tomogram (CT) of the para nasal sinuses were enrolled consecutively. The CT images were were studied in detail using RadiAnt DICOM viewer. The frontal recess cells were grouped as per the IFAC guidelines and their respective prevalence was calculated. The frontal recess cells were grouped as per the Opacification or mucosal thickening within these cells and the frontal sinuses were noted. A multivariate logistic regression analysis was done to evaluate the association between frontal sinus opacification and presence of various IFAC cells. RESULTS: A total of 640 IFAC cells were documented in 180 sides, of which 326 were anterior cells, 263 were posterior cells and 51 were medial cells. The most prevalent cell was the agger nasi cells(ANC), present in 91.7% of 180 sides, the supra agger nasi cells(SANC), Supra agger nasi frontal cells(SAFC), supra bulla cells(SBC), supra bulla frontal cells(SBFC), supra orbital ethmoidal cells(SOEC) and frontal septal cells(FSC) were present in 47.8%,37.8%, 65.6%,28.9%, 51.1% and 28.3% respectively. There was no significant association of presence of IFAC cells and frontal sinus opacification except for SBFC(p = 0.038). A significantly higher number of diseased frontal recess cells were seen with involved frontal sinuses when compared with non-involved frontal sinuses across all types of IFAC cells. CONCLUSION: The ANC were the most prevalent among all the IFAC cells and the FSC were the least prevalent. There was no significant association with the presence of different types of IFAC cells and frontal sinus opacification except for SBFC. However, there was a significantly higher number of diseased IFAC cells associated with frontal sinus opacification than in those without frontal sinus opacification.

Dupilumab Improves Facial Pain and Reduces Rescue Treatments in Patients with CRSwNP and Recalcitrant Frontal Sinusitis.

Recalcitrant frontal sinusitis in patients with chronic rhinosinusitis and nasal polyps (CRSwNP) has a negative impact on their quality of life due to frontal pain and a high risk of sinus occlusion, thus necessitating antibiotics, systemic corticosteroids, and multiple surgeries. The aim of this study was to assess the efficacy of dupilumab in reducing frontal pain and the need for rescue treatments for recalcitrant frontal sinusitis in patients with CRSwNP. We enrolled a cohort of 10 patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis associated with severe facial pain measured by MIDAS score who were treated with dupilumab 300 mg every 2 weeks and followed for at least 12 months. The mean MIDAS score decreased from 45.6 ± 10.7 at baseline to 1.3 ± 2.3 at 6 months (p < 0.05). VAS craniofacial pain decreased from 7.3 ± 1.6 at baseline to 1.2 ± 1.5 at 6 months (p < 0.05). No patient needed oral corticosteroids during treatment with dupilumab (p < 0.05), and the use of analgesics decreased from 9.6 ± 3.1 NSAID pills/week in the last 2 months at baseline to 0.6 ± 1.3 at 1 year of follow-up (p < 0.05). Our results demonstrated that use of subcutaneous dupilumab can improve symptom control, including recurrent severe cranio-facial pain, and reduce the need for rescue medical treatments (systemic steroids and NSAID) in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis.

A Rare Case of Occipital Subdural Abscess of Rhinogenic Origin: Case Report.

In the present day scenario complications arising from sinusitis are rare, since the introduction of antibiotics. However Sinusitis and its complications are still existing and masking of symptoms due to inadequate dosage and duration of antibiotics, which is life threatening and if neglected may result in high morbidity and mortality. This case has been presented for its rare presentation of parafalcine abscess of left occipital lobe of middle cranial fossa, which is secondary to frontal sinusitis. A 40 year old male patient was admitted in ICU with chief complaints of fever for 3 days, headache and neck stiffness for 2 days and altered sensorium for 1 day. Computed tomography showed both frontals, ethmoids and maxillary sinusitis on the left side. Patient was given conservative treatment and showed partial improvement of symptoms. On repeat CT brain (after 2 weeks) showed abscess parasagittally in left occipital lobe. Neurosurgeon aspirated abscess through parasagittal approach. Later the patient referred to the ENT department and ESS (endoscopic sinus surgery) DRAF II procedure done for clearance of frontal sinus to avoid recurrence of intracranial complications.

Silent sinus syndrome with interfrontal sinus retraction: A 3-case series using CARE methodology.

INTRODUCTION: Silent sinus syndrome (SSS) is a rare entity, almost exclusively involving the maxillary sinus, frontal location being very rarely reported. The aim of the present study was to describe clinical and radiological characteristics and surgical treatment using the CARE methodology. RESULTS: One woman and 2 men were referred for chronic unilateral frontal pain with imagery showing silent sinus syndrome. All showed partial or complete liquid opacification of the affected sinus associated with a thin interfrontal sinus (IFS) retracted toward the affected sinus. Functional endoscopic sinus surgery was performed in all cases, with good functional results. DISCUSSION: We describe 3 cases of SSS with IFS involvement. The frontal sinus wall seemed most vulnerable, probably most liable to be weakened by atelectasis. The study suggests that frontal SSS can be an etiology in chronic frontal sinusitis. Preoperative findings of IFS retraction are useful for surgical restoration of frontal sinus ventilation, relieving chronic pain and preventing complications.

Carolyn's Window Approach to Unilateral Frontal Sinus Surgery.

OBJECTIVES: Due to the complexity and variety of the frontal recess and sinus anatomy, traditional Draf 2a frontal sinus surgery is challenging. The thickness of the nasofrontal beak and anterior-posterior dimensions of the frontal recess contribute to this complexity. Carolyn's window technique eliminates the limitation of anterior-posterior depth to facilitate a Draf 2a frontal sinusotomy. The approach is a 0° endoscope technique and provides an excellent view of the frontal sinus and recess. We describe Carolyn's window approach to frontal sinus surgery and the perioperative outcomes. METHODS: Consecutive adult patients in whom Carolyn's window technique was applied for frontal sinus dissection as part of the endoscopic management of both inflammatory and neoplastic disease were assessed. The primary outcome was frontal sinus patency. Secondary outcomes were surgical morbidity, defined as early (<90 days) or late (>90 days). RESULTS: Forty-five patients (49.1 ± 17.9 years, 48.9% Female) were assessed. All patients had successful frontal sinus patency (100% [95CI: 92.1%-100%]). Morbidities were adhesion (4.8%), crusting (2.4%), pain (1.2%), and bleeding (1.2%) in the early postoperative period. There were no other morbidities in the early and late postoperative periods. CONCLUSION: Carolyn's window approach to frontal sinusotomy is a technique that evolves from previously described approaches. Successful frontal sinus patency with very low morbidities is achieved while still working with a 0° endoscope. The "axillectomy" performed simplifies frontal recess surgery by removing the anteroposterior diameter limitation and the dexterity required in angled endoscopy and instrumentation. The inferior-based lateral wall mucosal flap and free mucosal grafting expedite the mucosal healing process. Laryngoscope, 133:2496-2501, 2023.

A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades.

The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients' ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.

Frontal sinus obliteration with beta-tricalcium phosphate putty: case series with long-term radiological follow up.

OBJECTIVES: Frontal sinus obliteration is often performed using fat, autologous bone or a range of synthetic materials. This paper reports the long-term clinical and radiological outcomes of frontal sinus obliteration using beta-tricalcium phosphate putty. METHODS: A retrospective audit was performed of patients who underwent frontal sinus obliteration with beta-tricalcium phosphate putty. Patient-, disease- and procedure-related data were collected. Pre- and post-operative computed tomography scans were reviewed to assess bone integration. RESULTS: Four patients underwent frontal sinus obliteration using beta-tricalcium phosphate putty for treatment of a cerebrospinal leak, mucocele and recalcitrant frontal sinusitis. All patients had disease resolution, with no intra- or post-operative complications reported in the 16.5-month follow up. Post-operative computed tomography scans confirmed native bone obliteration of the frontonasal ducts in all patients. CONCLUSION: Beta-tricalcium phosphate putty is a safe and effective option for bone obliteration of the frontal sinus in a range of pathologies, including cerebrospinal fluid leak.