A combined approach modality was adopted for closure of the defect. The frontal sinus was approached from the nose after clearing ethmoid and frontal recess. The fovea ethmoidalis was found to be fractured but no CSF leak was found at this site. Using a 70 degree endoscope clear CSF was found coming from right frontal sinus. Right minifrontal sinusotomy was done and a 6mm bony defect found in the posterior table through which CSF Leak was noted .A large Fascia lata graft was used to close the defect which was reinforced with bone chips and fat, frontal sinus was stripped of the mucosa and obliterated with abdominal fat and fibrin glue was applied. Endoscopically frontal recess was obliterated with fat and anterior end of the middle turbinate released and rotated to reinforce the frontal recess closure. The assembled repair material was supported from below with gel foam merocel which was kept anchored by suture to prevent accidental aspiration. Post operatively standard medications to lower CSF pressure were prescribed and no lumbar drain was used.

through which CSF Leak was noted .A large Fascia lata graft was used to close the defect which was reinforced with bone chips and fat, frontal sinus was stripped of the mucosa and obliterated with abdominal fat and fibrin glue was applied. Endoscopically frontal recess was obliterated with fat and anterior end of the middle turbinate released and rotated to reinforce the frontal recess closure. The assembeled repair material was supported from below with gel foam merocel which was kept anchored by suture to prevent accidental aspiration. Post operatively standard medications to lower CSF pressure were prescribed and no lumbar drain was used.

mucosa and obliterated with abdominal fat and fibrin glue was applied. Endoscopically frontal recess was obliterated with fat and anterior end of the middle turbinate released and rotated to reinforce the frontal recess closure. The assembeled repair material was supported from below with gel foam merocel which was kept anchored by suture to prevent accidental aspiration. Post operatively standard medications to lower CSF pressure were prescribed and no lumbar drain was used.

The standard method of osteoplastic flap to approach the frontals leave significant cosmetic defects and using endoscopic technique avoids such issues. However the skill level for performing such combined procedures is high and possible only in centers with sufficient experience.