## 3 Discussion  
It should be emphasized that there are numerous factors that may have led to the development of this rare case, therefore several diseases are worth including in differential diagnosis aimed at identifying similarities between different conditions. One example is [PERSON]'s puffy tumor-subperiosteal abscess of the frontal bone with concomitant frontal sinusitis. Other nonobvious causes of [PERSON]'s puffy tumor have since been noted such as insect bites or the use of drugs by inhalation. It can also develop as a complication following acute mastoiditis, a dental infection, a neurosurgical procedure, an insect bite or use of drugs by inhalation. The condition most often affects young adults, but may be observed in any age group, occurring more frequently among men [11; 12; 13; 14]. A similar presentation is shared by osteomyelitisitis, caused by an inflammatory process that can develop in any of the paranasal sinuses [5]. A paranasal sinus mucocele is a cystic structure filled with mucus and exfoliated epithelium [15; 16; 17]. It most often develops by forming an anatomical stenosis, then blocking the normal passage. It continuously grows and compresses adjacent tissues, resulting in potential bone defects. If left untreated, diseases of the paranasal sinuses can lead to the spread of inflammation affecting adjacent tissues, especially in immunocompromised patients [18; 19; 20]. Such a lesion can occur intra-orbitally or even intracranially. The close presence of the meninges and the venous sinuses, especially the cavernous sinus, can cause threatening complications requiring neurosurgical treatment as they can even have fatal consequences [18; 20; 19]. During comprehensive treatment, the initial stage involves a commonly applied laryngological procedure called Draf III based on modern endoscopic techniques. The trans-nasal pathway leads to the frontal recess in the initial step. The next step involves complete removal of the inferior wall of the frontal sinus with partial resection of the anterior part of the perpendicular plate of the middle nasal concha [3]. In this clinical situation, due to the defect in the anterior wall of the frontal sinus, the intra-fistular approach was applied. The first references to the use of pedicled flaps date back to the 19 th century, when a pedicled flap based on the inferior epigastric vessels was used to reconstruct the forearm of a patient who had suffered a burn injury [8]. In addition, a stitched flap of the submandibular region was also used to reconstruct the buccal region after tumor removal [8]. [PERSON] describes a procedure for reconstructing a buccal defect with a unilateral pedicled flap based on the superficial temporal artery; in this case, the defect of the removed flap was covered with a free skin graft [8]. Finally, an island flap based on the temporal artery was used to reconstruct a defect of the lower eyelid by insertion into a tunnel created along the lateral edge of the orbit [8]. [PERSON] described a visor flap with a narrow pedicle based bilaterally on the temporal arteries. The developed plastic models were prepared according to his procedure [8]. The first stage involves dissection of a bilateral pedicle flap on the superficial temporal vessels (Figure 4A,B). The next step is to move the flap towards the defect area. A free skin graft is inserted in the space left by the dissected flap for about 10-14 days. The pedicle is then cut off and placed in the recipient site (Figure 4C,D). Due to the overgrowth of the created canal during the laryngological procedure, neurosurgical treatment was attempted. The key objective was to remove the mucosa, which in the future would impair wound healing after [PERSON]'s procedure, from the frontal sinus. Two methods were presented: the first was frontal sinus obliteration which was first applied as early as in the 19 th century. The procedure involves external access and total removal of the sinus along with the periosteum.