External Techniques in Frontal Sinus Surgery

Abstract

External techniques for frontal sinus surgery are often thought of as “historical” approaches that have been supplanted by endoscopic approaches. While the vast majority of frontal sinus pathology may be addressed by endoscopic techniques, select pathology still warrants external frontal surgery. This chapter details indications and surgical technique of external frontal sinus techniques. The modern approach to open frontal sinus surgery has dramatically evolved in intent and execution. Frontal sinus obliteration is not mandated when adopting an external frontal approach. External techniques may be used to restore sinus function, minimize tissue destruction, and preserve mucosa (functional “external” sinus surgery). External frontal techniques may be invaluable for recalcitrant inflammatory sinus disease that are not adequately addressed by prior endoscopic procedures or where the disease is far lateral and inaccessible through endoscopic approaches. Patients with malignancies, benign tumors, fractures, and CSF leaks may also require external frontal approaches. Additionally, open procedures may provide a faster, definitive option in cases where endoscopic techniques would necessitate significantly lengthier operative time for a successful outcome.