Overview of Frontal Sinus Pathology and Management

Key points

Anatomy of the frontal sinus

The frontal sinuses are absent at birth; they are visible radiographically as early as age 4. Paralleling general craniofacial growth, frontal sinus expansion peaks during adolescence and stops by around age 19. Unilateral or bilateral aplasia is seen in about 5% of people.¹

Frontal sinus anatomy is highly variable: in fact, it is unique to each individual, such that even monozygotic twins can be distinguished from each another on the basis of their frontal sinus configuration alone.² Indeed,

Overview of frontal sinus pathology and management

This section presents a brief overview of the main pathologic processes that affect the frontal sinus, with an emphasis on management principles. Most of these entities affect the frontal sinuses less commonly than the remainder of the sinonasal tract; in such cases, the topics are discussed broadly, since pathophysiology, workup, and management do not differ much.

Chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is defined as inflammation of the sinonasal tract lasting more than 12 weeks.⁵ Although this definition has a certain practical utility, it fails to capture the complexity of CRS. Most forms of CRS fall into one of two categories: CRS with polyposis or CRS without polyposis. However, CRS may also represent a common endpoint for a variety of systemic disorders.⁸ In discussions of CRS management, the concept of maximal medical therapy is often cited as the threshold

Overview of frontal sinus surgery

The history of frontal sinus surgery is long; trephination of the sinus appears to have been performed as early as the mid-18th century. External frontoethmoidectomy and various radical procedures were first performed in the late 19th century, and the well-known Lothrop procedure was described in 1914.²⁸ The advent of ESS in the early 1980s has obviated the need for most open surgery; however, these techniques (see Lawson W, Ho Y: Open Frontal Sinus Surgery: A Lost Art, in this issue) remain a

Summary

Management of frontal sinus pathology in general remains among the more challenging subjects in otolaryngology, and frontal sinus surgery specifically represents one of the most interesting facets of surgical rhinologic practice. This issue aims to present a detailed, up-to-date, evidenced-based review of the issues most relevant to frontal sinus management today.