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Related Experiment Video

Updated: Nov 18, 2025

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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A stepwise approach to open surgery for the frontal sinus.

A Kelly1, N Alhelali1, G W McGarry1

  • 1Otorhinolaryngology Department, Glasgow Royal Infirmary, Scotland, UK.

The Journal of Laryngology and Otology
|February 11, 2021
PubMed
Summary

External frontal sinus surgery remains necessary despite endoscopic advances. A new rule of thumb leverages embryological development for safer external approaches, particularly useful for complex cases unresponsive to endoscopic sinus surgery.

Keywords:
FenestrationFrontal SinusObliterationOsteoplastic FlapTrephination

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Surgical Anatomy

Background:

  • Endoscopic sinus surgery has limitations, necessitating external approaches for some frontal sinus conditions.
  • The anatomical variability of the frontal sinus presents surgical challenges.
  • A novel approach utilizes consistent embryological development for safe external access.

Purpose of the Study:

  • To present a reliable rule of thumb for safe external frontal sinus access.
  • To describe a stepwise surgical technique for frontal sinus management.
  • To evaluate the efficacy of obliteration for refractory frontal sinus symptoms.

Main Methods:

  • A stepwise surgical approach involving trephination, fenestration, and osteoplastic flap creation.
  • Frontal sinus obliteration as a definitive management strategy.
  • Application of a rule of thumb based on embryological development for surgical planning.

Main Results:

  • The described stepwise approach facilitates safe external access to the frontal sinus.
  • Osteoplastic flap and obliteration yielded good results for patients with disabling symptoms.
  • This method proved effective for patients who failed multiple endoscopic procedures.

Conclusions:

  • A rule of thumb based on frontal sinus embryology enhances surgical safety for external approaches.
  • Frontal sinus obliteration is a successful treatment for disabling symptoms refractory to endoscopic surgery.
  • External surgical techniques remain valuable for complex frontal sinus cases.