William Lawson1, Anthony Reino2 and Robert Deeb3*
1Department of Otolaryngology, Head and Neck Surgery, Mount Sinai School of Medicine (WL), New York, USA
2Department of Otolaryngology, Head and Neck Surgery, James J Peterson Veterans Affairs Medical Center (AR), Bronx, New York, USA
3Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan (RD), USA
Received: 13 July, 2017; Accepted: 17 August, 2017; Published: 18 August, 2017
Robert Deeb, MD, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA, Tel: 313-916-3272; Fax: 313-916-7263; E-mail:
Lawson W, Reino A, Deeb R (2017) The Riedel Procedure - An Analysis of 22 Cases. Arch Otolaryngol Rhinol 3(3): 087-092. DOI: 10.17352/2455-1759.000054
© 2017 Lawson W, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Riedel procedure; Frontal sinus osteomyelitis
Objectives: To report one institution’s experience with 22 cases of the Riedel procedure in order to establish a profile for those patients with chronic frontal sinusitis who develop chronic osteomyelitis.
Study Design: Retrospective review.
Methods: Review of all patients undergoing the Riedel procedure at one institution with analysis of demographic data, indications for procedure, technical aspects of performing the procedure, outcomes and complications. Comprehensive review of the literature was performed as well.
Results: Twenty-two patients were identified. The age range in patients varied from 20 years to 86 years. The etiology of the condition requiring the Riedel procedure was infectious in 16 patients, traumatic in 5 and neoplastic in 1. All patients with chronic osteomyelitis of the frontal sinus had undergone multiple intranasal and external procedures. Post-operative follow-up interval ranged from 4 months to 21years.
Conclusion: The Riedel procedure remains a relevant tool in the armamentarium of the rhinologic surgeon. Its primary indication, chronic frontal osteomyelitis, is an indolent process that generally occurs as sequelae of Pott’s Puffy tumor, trauma or neoplasm. The natural history is that of multiple failed endoscopic and open procedures. Despite the radical nature of the Riedel procedure, it may not be curative and patients require long term follow up.
The Riedel procedure is a radical ablative operation devised in 1898 when, in the pre-antibiotic era, acute and chronic frontal sinusitis carried a high morbidity and mortality. Curiously it persists as part of the armamentarium of the sinus surgeon over a century later. Despite all the advances made in modern therapeutics, imaging and instrument technology, a small subset of patients persists with chronic refractory frontal osteomyelitis that has defied conventional management. It is the purpose of this paper to report our experience with 22 cases undergoing the Riedel procedure to establish a profile for those patients with chronic frontal sinusitis who insidiously develop chronic osteomyelitis and ultimately require radical ablative surgery.
Materials and Methods
A comprehensive chart review of all patients presenting to the senior authors (W.L. and A.R.) requiring the Riedel procedure was performed. Basic demographic information was recorded. The entire pre-operative, operative and post-operative course of all patients was reviewed including previous procedures and complications. A comprehensive literature review of frontal osteomyelitis and its management was performed as well.
A retrospective review of the records at the Mount Sinai Medical Center, New York, NY, revealed 22 patients who had undergone the Riedel procedure in the period of 1975 to 2001 by the senior authors (W.L and A.R.). The follow-up interval ranged from 4 months to 21 years with a mean of 6 years. Table 1 represents a summary of the cases. Twenty males and 2 females with an age range of 20 to 86 years comprised the study group. Among 20 patients with chronic osteomyelitis, the mean age was 51, with a bimodal distribution (20-40 years in 10 cases, 55-86 years in 10 cases). Fifteen patients presented with refractory osteomyelitis and Pott’s puffy tumor and fistulae secondary to chronic infection of the frontal sinus (Figure 1). Five patients had sustained severe trauma to the frontal sinus secondary to motor vehicle accidents and gunshot wounds and subsequently developed chronic osteomyelitis of the frontal bone (Figure 2). The interval between the injury and the onset of osteomyelitis was generally prolonged ranging from 2 to 25 years. One patient had squamous cell carcinoma of the frontal sinus. All patients with chronic osteomyelitis of the frontal sinus had undergone multiple intranasal and external procedures as listed in table 2.