Chronic frontal paranasal sinusitis is one of the challenging ailment in ENT field.
Earlier Tato, Bergara and Goodale have reportedly treated the frontal sinusitis by filling the sinus by autogenous fat or iliac bone.
We have been filling the sinus by deproteinized heterogenous bone (Kiel Bone). Clinical and animal experiences have been accumulated. This filling material (Kiel Bone) was originally developed by Maatz and Bauermeister in West Germany by deproteinizing the calf bone with hydrogen peroxide. In animal experiments, the Kiel Bone was filled into the frontal (or maxillary) sinus of the dogs (or monkeys). The animals were sacrificed in a certain periods for histologic examination of the filling material. In 20 days bone regeneration was already recognized and the newly grown bone with rafts were observed in 110 days.
No foreign body type reaction was demonstrated. Clinically the material was packed into 82 chronically inflammed frontal paranasal sinuses of 51 patients. Postoperative course was uneventful on all patients but 5 who developed infections.
The infections took place in 6 sinuses of the 5 patients.
This indicated 90.2% success rate on the patients treated and 92.7% success rate on the sinuses treated.
The infections occured 9.8% of the patients treated and 7.3% of the sinuses treated.
Causes of the failure were presumed to be remaining mucosa left by untrained surgeons and the infection during and after the operations.
The fact that no immunologic reaction was responsible for the failure was proved by clinical and pathological investigations.
Postoperative pneumatization of the sinuses was observed on only 2 patients (3.9%).
This figure was apparently less than 22.7% of the re-pneumatization following the classical frontal sinus operations.
However, these figures are not lightly to be compared because averge follow up periods are only one year and 8 month (the longest is 4 years so far).
The histologic examinations of the clinical cases showed satisfactory results.
From these results, the frontal sinus filling operation using the Kiel Bone is considered to be practical procedures However for the stisfactory clinical result, indication should be thoroughly evaluated, because the time honoured intra-nasal or extra-nasal operations (preferably combined by osteoplastics of the anterior wall) are still good procedures.
The indications of the frontal paranasal sinus filling operation using the Kiel Bone are; 1) cases in which permanent patency of the ductus naso-frontalis is not expected, 2) recurrent frontal sinusitis, 3) giant sinus which is likely to cause local deformity postoperatively.
Main advantages of the Kiel Bone graft to the autograft are;1) easy preservation and sterilization, 2) supplies are unlimited, 3) shorter operative time, 4) less pain to the patient, 5) ischemic necrosis of the filling material needs not to be worried.
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