Combined endoscopic and minitrephination techniques in the surgical management of frontal sinus type IV cell disease

Objective: The aim of the study was to present minimally invasive combined endoscopic and minitrephination techniques in the surgical management of frontal sinus type IV cell disease. Methods: Case report of a 44-year-old man with localized pain in the right forehead. Computed tomography of the sinus revealed an opacified expanding type IV cell within the right frontal sinus, draining into the frontal sinus itself. An endoscopic approach through the frontal recess was not successful in reaching this cell. A minitrephination approach was then used and an endoscope was inserted through the trephination hole. Instruments were inserted endoscopically into the right frontal sinus through the frontal recess and then using direct endoscopic visualization through the minitrephination access, the frontal cell was opened and marsupialized. Results: The patient recovered uneventfully with his localized frontal pain completely resolved 3 years after surgery. Conclusion: The minitrephination approach can be used to introduce an endoscope into the frontal sinus to assist in the surgical management of remote cephalad and lateral lesions within the sinus that are otherwise difficult to reach using endoscopic techniques alone.