Endoscopic Trans-septal Frontal Sinusotomy

The drainage pathway of the frontal sinus is hidden from the direct endoscopic view by a complex and variable pattern of cells in the frontal recess. The proximity to critical structures, including the skull base and the orbit, further adds to the challenge of safe and successful surgery in the frontal sinus. The advent of endoscopic techniques and the development of sophisticated frontal sinus hand instrumentation, shavers, high-speed drills, and computer-aided surgery have greatly facilitated the management of frontal sinus disease [6, 11]. Despite these advances, frontal sinus disease remains refractory in a subset of patients. This is often related to neo-osteogenesis resulting in complete or near-complete stenosis of the frontal recess. While meta-analysis has shown no significant difference in frontal sinusitis following partial or total middle turbinate resection compared to middle turbinate preservation, an inadequately resected remnant of the turbinate that forms synechiae to the lateral nasal wall and narrows the frontal recess may also be a contributing factor in postoperative frontal sinus stenosis [12, 13].