Abstract
Surgery of the frontal sinus can be very challenging, given the highly variable and complex anatomy of the frontal sinus and frontal recess. Most endoscopic procedures directed at the frontal sinus are performed in patients who previously underwent sinus surgery. In these patients, it is common to find anatomic variants that predispose the patient to frontal sinus disease, as well as scarring and osteoneogenesis. Many patients have a combination of these factors. In particular, incomplete removal of the obstructing agger nasi cell and frontal cells may be identified. Given the variable anatomy of the region and the close proximity to vital structures, image-guidance may serve as a useful adjunct to the surgeon in selected cases. Two situations where we have found image-guidance particularly useful are in cases of severe scarring and osteoneogenesis and in cases where obstructing frontal cells are present.
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