Frontal Sinus Ablation

To the Editor.—I read with interest the excellent article entitled "Frontal Sinus Ablation by Cranialization: Report of 21 Cases" by Donald that was published in the MarchArchives(1982;108:142-146). This procedure provides a solution to the cosmetic problem of severe frontal sinus trauma. I believe it does so with the risk that new problems will be introduced by this technique. The concern I have is that the nasofrontal duct system is transposed from an extracranial to an intracranial position by the procedure. The formation of a mucocele, under these conditions, will be intracranial and will be beneath the reconstructed anterior bony wall of the forehead. Thus, the mucocele may grow rather large before there is any evidence of it. For example, I saw a patient who had an intracranial mucocele. I have no idea how long the mucocele was present; however, the patient began to have rather minor symptoms