Modern concepts of frontal sinus surgery

Objectives/Hypothesis: To validate the endonasal surgical approach to front al sinus in inflammatory sinus disease, trauma, and selective tumor surgery , and to define the role of external approaches to the frontal sinus. Endon asal frontal sinusotomy can range from endoscopic removal of obstructing fr ontal recess cells or uncinate process to the more complex unilateral or bi lateral removal of the frontal sinus floor as described in the Draf IT-m dr ainage procedures. In contrast, the osteoplastic frontal sinusotomy remains the "gold standard" for external approaches to frontal sinus disease. Meth ods: A retrospective review of 1286 patients undergoing either endonasal or external frontal sinusotomy by the authors at four university teaching pro grams from 1977. Prior author reports were updated and previously unreporte d patient series were combined. Results: Six hundred thirty-five patients u nderwent type I frontal sinusotomy, 312 type II sinusotomy, and 156 type II I sinusotomy. A successful result was seen in these groups, 85.2% to 99.3%, 79% to 93.3%, and 91.5% to 95%, respectively. External frontal sinusotomy or osteoplastic frontal sinusotomy was successfully performed in 187 of 194 patients. Clinical symptoms, endoscopic findings, computed tomography, and magnetic resonance image scanning, and reoperation rate measured postopera tive success. Conclusions: A stepwise approach to the surgical treatment of frontal sinusitis, trauma, and selective benign tumors yields successful r esults as defined by specific criteria which vary from 79% to 97.8%. The de tails of specific techniques are discussed, essential points emphasized, an d author variations noted.