Frontal Sinus Surgery: Selection of Technique

Abstract

The selection of the surgical approach to the frontal sinus should be personalized. The selected technique should be tailored to address the disease effectively while minimizing the risks of complications and postoperative sequelae. Factors that determine the choice of approach include the location, extent, and pathology of the disease, the variants of frontal sinus anatomy, the surgeon's level of expertise, and the availability of frontal-specific instrumentation. These determinants have been discussed in previous chapters. In the modern era, endoscopic techniques have supplanted most external techniques. However, external techniques remain relevant and at times invaluable for specific pathologies. Additionally, the supplementary use of certain external techniques such as the frontal trephination may facilitate effective, safe, and efficient endoscopic surgery. In the contemporary era, a function-restoring philosophy (``functional external sinus surgery'') can be applied to many patients that historically might have been obliterated. Obliteration and cranialization of the frontal sinus remain useful techniques but are usually necessary only for rare indications.