ABSTRACT
In the past the frontal sinus has been regarded as the most difficult area of endoscopic sinus surgery.1-3 The frontal sinus is situated behind the frontal beak and the anatomy in this region can be quite variable. In addition the thin bone of the lamina papyracea (orbit) and lateral wall of the cribriform plate form the lateral and medial boundaries that are at risk during surgery in this region. The frontal recess may also vary considerably in size, and in patients with a narrow frontal recess, adhesion formation and postoperative fibrosis may occur after minimal surgical trauma.4,5 Cells in the frontal recess may be positioned to a variable extent around the frontal recess, further narrowing or obstructing the recess. In the past these factors have led surgeons to suggest that surgery in this region should not be performed and that surgically treating the maxillary sinus ostium and bulla ethmoidalis may result in resolution of disease in this area;5 however, the so-called minimally invasive sinus treatment (MIST) has not been shown to achieve this goal.6 Another suggestion that has been made is that the frontal sinus should only be operated on if there were symptoms that could be related directly to the frontal sinus. However, this argument is also flawed as we know that frontal pain or headaches are only one symptom of chronic frontal sinusitis and that the diseased frontal sinuses also contribute substantially to the symptoms of nasal obstruction, rhinorrhoea and postnasal drip.
