Surgical management of frontal sinusitis

The surgical management of chronic frontal sinusitis continues to evolve. There is no single surgical approach that will lead to successful resolution of disease and symptoms in all cases, and many options must be considered. These options generally attempt to restore drainage and ventilation to the sinus or to obliterate the sinus. When chronic frontal sinusitis fails to respond to maximum medical management, surgical treatment should proceed in a logical progression from simple to more radical procedures. Advanced imaging techniques can offer critical information in this area of highly variable and complex anatomy. Most endoscopic procedures directed at the frontal recess are performed in patients who have previously undergone sinus surgery. In these patients, it is not uncommon to find anatomic variants that predispose the patient to frontal sinus disease as well as scarring and osteoneogenesis. When attempts to restore drainage and ventilation fail, osteoplastic flap with obliteration remains the time-honored treatment even though it is associated with substantial surgical morbidity and renders the otolaryngologist less able to evaluate the frontal sinus endoscopically or radiographically.