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The otolaryngic procedure regarding the frontal sinus injury is made

easy by virtue of the extensive craniotomy needed for controlling the

intracranial injury. The initial step in the procedure is to ensure all the

bony fragments from the anterior wall of the frontal sinus have been

saved. These are divested of dirt and soaked in Betadyne

until the end

of the procedure. The posterior wall of the sinus is completely removed,

so that the cavity of the frontal sinus is now in continuity with the

anterior cranial fossa. This is begun with a double-action rongeur and is

finished off with a cutting bur (Figure 3.6). The frontal sinus mucosa is

now completely stripped out with an elevator from the floor and

remaining anterior wall, such that the remaining sinus cavity is com-

pletely divested of mucosa. Total removal of all mucosal remnants of

the sinus is ensured by removing 1–2 millimeters of bone with a cutting

burr (Figure 3.7).

Figure 3.6

Cranialization procedure—Brain is

debrided, dura is patched, and

posterior wall remnants are

removed with double-action

rongeur.

Figure 3.7

Cranialization procedure—Removal

of the remaining posterior wall of

the frontal sinus produces

cranialization.