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Cranioplasty in facial feminization surgery (FFS) contours the frontal bone to achieve an improved feminine appearance of the forehead. A critical component of frontal cranioplasty is the ability to safely and effectively reduce bony prominence overlying the frontal sinus. This procedure video illustrates use of frontal sinus transillumination for estimation of sinus configuration for cranioplasty during FFS. With the entire bony forehead exposed, a 4-mm rigid sinuscope attached to a light source is inserted into the nasal cavity with its tip positioned at the anterior middle meatus angled to transilluminate the frontal sinus. Transillumination demonstrates that in this patient, the bilateral lateral aspects of the frontal bossa rest over solid bone, not sinus, and that the patient has multiple sinus septations rather than a single intersinus septum. The transilluminated boundary and the intersinus septae are marked with a pen, and areas of frontal bossing that extend beyond the sinus boundary are shaded. Then, a high-speed drill (20 000 revolutions per minute [rpm]) with a 5-mm cutting burr is used to remove frontal bossing within and outside of this zone without concern for accidentally entering the frontal sinus. For a complete description of the technique and surgical approach and a demonstration of the same procedure in a second patient, see the link below.
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