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A 55-year-old female complains of (C/O) sinusitis, right-left (R>L), previously treated by local otolaryngologist, mild right frontal headache. The patient has a history of essential hypertension, hypothyroidism, hypercholesterolemia and motor vehicle accident (MVA) in 1979 with multiple trauma, open reduction of arm fractures, intensive care unit (ICU) stay but no facial fractures…


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  1. Zaixing Wang

    Very exciting surgery, I have a question about repairing the defect of the anterior skull base. Is it necessary to repair the defects in the structure of the bones? Is it possible to use muscle tissue and septal mucosa?thank you.

    1. David W Kennedy

      We feel that it is only necessary to use a mucosal layer in patients who do not have raised intracranial pressure. In this case, we did place an intracranial bone/cartilage graft intracranially, because the patient also had an empty sella – but the cause of this was almost certainly from her prior accident and not as result of raised intracranial pressure. The key is meticulous preparation of the skull base (removing mucosa, making it completely flat) , and careful placement of the graft and packing

  2. Changxing Liu

    What are the major symptoms? What are the findings on nasendoscopy? Any scans were done? What’s showed on the imaging studies?

    1. David W Kennedy

      I am not sure that I understand the question, Dr Liu. The symptoms and the nasal endoscopy findings are described in the initial history, and the scans are in the presentation. The final nasal endoscopy is seen in the video. Perhaps if you have more specific questions they can be answered.


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