Frontoethmoidectomy with Sewall-Boyden reconstruction: alive and well, a 25-year experience

Recent controversies in the rhinologic literature regarding surgical management of the frontal sinus center around relatively new techniques using endoscopic intranasal approaches. Few authors have addressed the concept of frontal "duct" reconstitution, relying instead upon variations of the stenting concept, which fail at least 30% of the time. Some oral presentations and discussions in the past have gone so far as to say that external frontoethmoidectomy is an antiquated operation with few indications. One reason for its recent disfavor concerns the reported high rate of postoperative naso-frontal drainage track stenosis leading to recurrent disease. The senior author has a 25-year experience with a frontal recess reconstruction technique known as the Sewall-Boyden flap. This technique, coupled with the frontoethmoidectomy approach, has been effective with a low failure rate in 41 cases. This article serves to remind sinus surgeons of a safe, effective technique for establishing a drainage track from the frontal sinus: external fronto-ethmoidectomy with Sewall-Boyden flap reconstruction.