Is there a reason for performing frontal sinus trephination at 1 cm from midline? A tomographic study.

UNLABELLED: The complex anatomy of the frontoethmoidal recess, as well as its anatomical relationship with the vital adjacent structures in the region explain the reason for considerable surgical care to protect these structures and minimize complications related to healing. Trephination is an accepted procedure to access the frontal sinus. AIM: Discuss the best location for performing frontal sinus trephination. METHODS: Measuring sinus frontal depth at 3 points equidistant to the midline (crista galli) through the axial tomographic sections. RESULTS: We measured 138 frontal sinus (69 patients). Frontal sinus depth at 0,5 cm was statistically larger than 1 cm and 1.5 cm, as well as the 1 cm trephine point was significantly larger than 1.5 cm (12.22+/-4.25 vs 11.78+/-4.65 p<0,05; 12.22+/-4.25 vs 10.78+/-5.98 p<0.001; 11.78+/-4.65 vs 10.78+/-5.98 p<0.05). The trephine set used (maximum depth of penetration of 0.7 cm) is safe to be applied in approximately 80% of the patients. CONCLUSION: Analyzing the results, the trephination may be performed at variable points of the frontal sinus, but the distance of 1 cm from midline appears to be safer and shows better aesthetic results.