Contemporary issues in frontal sinus surgery

Despite dramatic advances in the instrumentation and diagnostic imaging available for the treatment of paranasal sinusitis, the surgical management of chronic frontal sinusitis continues to challenge otolaryngologists. The variety of surgical options that exist attests to the complexity of this disease, and no single approach provides a successful resolution in all cases. The literature supports a graduated approach progressing from minimally to more invasive procedures. Initial attempts focus on reestablishing ventilation and drainage, but when this fails, the time-honored treatment remains use of an osteoplastic flap with adipose obliteration. However, obliteration is not the panacea, as even this operation leaves the patient with significant potential morbidity, such as frontal neuralgia, external cosmetic deformity, and the limited ability to follow the obliterated sinus radiographically for recurrent disease.