Frontal sinus ablation (Riedel-Mosher's procedure): indications and role in the endonasal endoscopic era

Abstract

Background:The aim of this article is to describe the Riedel-Mosher's surgical technique and identify its current role in the endoscopic endonasal era based on the experience of a tertiary care medical centre. It also provides a brief excursus on materials available for frontal reconstruction.Methods: A retrospective review of patients submitted to Riedel-Mosher's procedure from 2005 to 2018 at a single tertiary care centre was carried out. Details of the surgical technique along with data on frontal reconstruction timing and materials used were collected.Results: A total of 21 patients (16 males and 5 females) underwent the Riedel-Mosher's procedure. The age of the patients ranged from 15 to 84 years. The underlying pathology was represented mainly by chronic osteitis of the frontal bone (17 cases), followed by benign tumours (3 cases) and malignancy (1 case). Perioperative complications occurred in 3 patients. Cranioplasty was carried out only on 16 cases and delayed by an average time of 10 months. Materials for reconstruction included titanium, ceramic, plastic and free flap .Conclusions: Nowadays, Riedel-Mosher's procedure is still indicated in selected cases of benign and malignant pathologies of the frontal sinus and/or frontal bone. Surgical expertise is key to approach the frontal sinus safely. Its reconstruction requires proper planning and a wide variety of materials to perform it is now available.

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

“…Owing to the rarity of SCC arising from the frontal sinus, [ 119 ] principles of reconstruction of frontal bone defects resulting from oncologic ablations are less univocally defined. Cranioplasty through titanium, ceramic, or plastic implants is among the most frequently employed strategies, and most invariably requires a two-stage surgery [ 120 ]. Autogenous calvarial grafts [ 121 ] or free flaps [ 122 , 123 , 124 ] have also been described to reconstruct defects of the frontal bone.…”

Comprehensive access strategies to the frontal sinus

“…osteomyelitis of anterior and posterior walls, with or without skin fistula), extensive Pott's puffy tumour, resorption of the frontal bone after previous craniotomy, comminuted fractures of anterior/posterior walls, benign and malignant tumours with extensive involvement of anterior and/or posterior bony walls of the frontal sinus (Fig. 3) [38,39,40 & ].…”

“…This is prevented by leaving the bony flap pedicled inferiorly, with a greenstick fracture of its inferior edge. Globally, the invasiveness of external approaches is more relevant, leading to a considerable rate of complications that must be considered in up to 30% of the cases [38,42], including mainly CSFL and persistent infection.…”

Reconstruction of Anterior Table Frontal Sinus Defects with Pericranial Flap and Titanium Mesh

“…In some situations, frontal sinus pathology necessitates removal of the anterior table. 1 This technique can be quite disfiguring as it results in a significant frontal bone defect and resultant forehead depression. The anterior table defect poses a reconstructive challenge and very few publications have described reconstructive options.…”