Management of the frontal sinuses

The anatomy of the frontal recess/frontal sinus can be very complex and may predispose to frontal pathology in case of mucosal disease. For this reason, surgery of the frontal recess should only be performed by surgeons with a full understanding of the anatomy and with the right instrumentation. Acute frontal sinusitis is a rare disease and seldomly needs surgical intervention. Endonasal frontal sinus surgery can range from functional endoscopic removal of obstructing frontal recess cells or uncinate process with preservation of the mucosa (Draf IIa) to the extensive drillouts where the floor of the frontal sinus is removed to create a neo-ostium of maximal size. Most problems in the frontal sinus, such as inflammatory disease, (lateral) mucoceles, tumors, CSF leaks, and fractures, can be solved endoscopically. If the lesion cannot be reached or the neo-ostium cannot be kept open, an osteoplastic flap with or without obliteration of the frontal sinuses may be indicated.