Frontal Sinus Surgery: Selection of Technique

  • Devyani Lal
  • Peter H. Hwang


The selection of the surgical approach to the frontal sinus should be personalized. The selected technique should be tailored to address the disease effectively while minimizing the risks of complications and postoperative sequelae. Factors that determine the choice of approach include the location, extent, and pathology of the disease, the variants of frontal sinus anatomy, the surgeon’s level of expertise, and the availability of frontal-specific instrumentation. These determinants have been discussed in previous chapters. In the modern era, endoscopic techniques have supplanted most external techniques. However, external techniques remain relevant and at times invaluable for specific pathologies. Additionally, the supplementary use of certain external techniques such as the frontal trephination may facilitate effective, safe, and efficient endoscopic surgery. In the contemporary era, a function-restoring philosophy (“functional external sinus surgery”) can be applied to many patients that historically might have been obliterated. Obliteration and cranialization of the frontal sinus remain useful techniques but are usually necessary only for rare indications.

This concluding chapter will detail the editors’ philosophical approach to the selection of technique for frontal sinus surgery. This chapter will highlight anatomical and pathological considerations that dictate choices using illustrative cases and videos.


Frontal sinusotomy Draf I Draf II Modified endoscopic Lothrop Draf III Frontal sinus External frontal surgery Frontal trephination Frontal sinus obliteration Cranialization 

Supplementary material

Video 30.1

Draf IIB procedure for severe inflammation, friable mucosa, osteitis with stenting (WMV 20787 kb)

Video 30.2

Draf IIB for lateralized right middle turbinate stub (WMV 67842 kb)

Video 30.3

Draf III (primary) for neo-osteogenesis in a patient with extensive neo-osteogenesis of the frontal recess (MPG 149120 kb)

Video 30.4

Allergic fungal sinusitis months post-op after a Draf IIA procedure (WMV 3661 kb)

Video 30.5

Draf IIB for inverted papilloma of the right frontal sinus (WMV 80854 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Devyani Lal
    • 1
  • Peter H. Hwang
    • 2
  1. 1.Department of Otolaryngology – Head and Neck SurgeryMayo Clinic College of Medicine and Science, Mayo ClinicPhoenixUSA
  2. 2.Department of Otolaryngology – Head and Neck SurgeryStanford University School of MedicineStanfordUSA

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