An interesting case of fronto cutaneous fistula

Fronto cutaneous fistula is a very rare entity which usually occurs as a complication of long standing frontal sinusitis leading to frontal bone osteomyelitis. Its incidence has decreased due to the wide spread use of antibiotics. In this era we would like to report a rare case of fronto cutaneous fistula secondary to sino nasal malignancy. A 65 year old female presented to the ENT out patient service of our Hospital with complaints of discharging sinus in the left forehead for 2 months. There was blurring of vision in the right eye for one year .She was a known diabetic. General examination showed that there was a mild swelling around the right orbit and the right eye was significantly proptosed. Routine ENT examination revealed that there was a suspicious nasal mass in the right nasal cavity on anterior rhinoscopy later confirmed by diagnostic nasal endoscopy. Ear and Throat were normal. Neurology opinion was obtained which stated that the findings were suggestive of an intracranial Space occupying lesion extending into the right orbit. Urgent CT was ordered. Routine laboratory investigations were normal except the ESR value which was 60 mm at end of 1 hour. CT scan showed a sinonasal mass existed centered over the right nasal cavity extending into the surrounding sinuses, near complete erosion of lamina papyracea with extension into right orbit. Biopsy of was done. The biopsy showed squamous cell carcinoma with poorly to moderately differentiated cells. However as the patient was not willing for surgery, hence chemoradiation was advised.