Primary endoscopic surgery

Primary endoscopic surgery of the frontal sinus is a technically challenging procedure that requires a thorough understanding of the three-dimensional anatomy of the frontal recess. In addition to recognizing the various types of frontal recess cells as described by Kuhn, the configuration of the uncinate process must be appreciated in order to perform a well-planned operation. The traditional approach to the frontal recess involves dissection of ethmoid cells in a posterior to anterior direction. However, other approaches are described, such as the anterior approach via the agger nasi cell. Angled instrumentation, including powered debriders, are crucial to performing a thorough dissection of frontal recess cells while preserving mucosa. These techniques combined with close postoperative surveillance have produced excellent outcomes with this procedure.