[Surgical treatment of osteomyelitis of the frontal bone and the walls of the frontal sinus].

Having in view observations made during surgical treatment of 21 patients with frontal bone osteomyelitis of traumatic (18 patients) and rhinogenic (3 patients) origin, three varieties of osteomyelitis can be distinguished, viz. osteomyelitis of frontal squama, osteomyelitis of frontal sinus wall, and mixed osteomyelitis involving nasal bones. Three therapeutic approaches are recommended: closed healing of the wound after dissecting the fistula and removal of osteomyelitic bone lesions, drainage of frontal sinuses via the frontonasal anastomosis, and tamponade of the cavity, that developed after the resection of the pathological focus, with the host muscle tissue. In advanced osteomyelitis of the frontal sinus walls, preference should be given to the neurosurgical approach with a wide revision of the pathological focus, removal of the mucosa, suppurative epidural layers and further formation of an enlarged frontonasal anastomosis and prolonged drainage of the cavity for 24 to 30 days. When treating osteomyelitis of frontal squama with its significant enlargement, the most efficient method is tamponade of the cavity formed by the hard membrane, skin and bone with the host muscle. Small osteomyelitic lesions of the frontal bone can be removed by dissecting the fistula, 3-4 day draining and suturing the wound.