Radiologic Evidence of Delayed Frontal Sinus Disease After Feminizing Frontal Cranioplasty

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OBJECTIVE: Feminizing frontal cranioplasty (FFC) is an essential technique in feminization of the upper third, often involving the violation of the anterior table of the frontal sinus. Though case reports document frontal sinus complications years after surgery, no studies to date examine the presence of delayed frontal sinus disease on long-term imaging after FFC. STUDY DESIGN: Case series. SETTING: Tertiary care center. METHODS: Adult patients who underwent FFC with type III forehead classification between August 2016 to December 2019 were offered postoperative computerized tomography (CT) scans. Preoperative and postoperative CTs were compared using the Lund-Mackay (LM) scoring system and assessed for frontal sinus disease. Retrospective chart review for demographic data and new diagnoses of sinusitis were extracted. RESULTS: A total of 40 transfeminine patients were included. The average time from surgery to postoperative CT scan was 71 months (median: 67.5 months; range: 56-96 months). The mean preoperative and postoperative total LM scores were 0.98 and 1.05 (P = .83), respectively. The mean frontal sinus-specific preoperative and postoperative LM scores were 0.2 and 0.15 (P = .64), respectively. Though 5 (12.5%) patients exhibited trace frontal sinus mucosal thickening on postoperative CT scans, significant frontal sinus pathology (eg, mucoceles, osteomyelitis, sinocutaneous fistula) was not found in any patient, and none required surgical treatment for sinus-related disease. CONCLUSION: FFC is a relatively safe procedure with low risk for frontal sinus-related complications within the first 6 years after surgery. Continued surveillance should be considered to detect serious frontal sinus pathology that may develop beyond this timeframe.

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