Frontal sinus ablation for frontal osteomyelitis.

Frontal sinusitis with frontal osteomyelitis is a potentially life threatening disease. Diagnostic and therapeutic errors occur frequently because of antibiotic masking of already silent frontal lobe complications or lack of suspicion on the part of the otolaryngologist or the neurosurgeon. Frontal sinus infection and/or trauma frequently require otoneuro cooperation for care. Four cases of complications of frontal sinus infection with osteomyelitis are discussed. Three had epidural empyemas and one had a subdural empyema with an anterior 1/3 superior sagittal sinus thrombosis and multiple brain abscesses. Each patient was approached through a frontal craniotomy and the frontal sinus posterior plate examined from behind. Each had posterior dehiscences. Follow-up of osteomyelitis requires multiple tests including computerized tomography, polytomography and possibly bone or gallium scans. Twenty year or more follow-up is essential.