Frontal sinus surgery: the state of the art.

Aim: Review and describe the essential components of modern frontal sinus surgery. Background: Frontal sinus surgery has evolved considerably over the last century, and advances in imaging, optics, and instrumentation have contributed to contemporary treatment paradigms. Outcomes assessment has had an important role in identifying indications for surgery and future areas of research. Review results: Numerous advancements are part of modern frontal sinus surgery and the treatment of frontal sinusitis. Ana­ tomic studies have revealed variations that are associated with disease and pose challenges for surgery. Open approaches remain relevant in situations of difficult disease or as part of combined approaches. Endoscopic surgery, however, is central to contemporary surgical management of frontal sinus disease. Evolving instrumentation and the development of new implan­ table devices are increasingly relevant in the endoscopic era. Outcomes research has refined indications for surgery and identifies areas for ongoing research. Conclusion: State­of­the­art frontal sinus surgery is the pro­ duct of significant evolution and advancement. Modern surgery is reflective of improved optics and new instrumentation, and the central role of endoscopic approaches in treating frontal sinus disease. Outcomes research has been essential for developing an evidenced­based approach to frontal sinus surgery. Clinical significance: A review of the essential components of state­of­the­art frontal sinus surgery for the practicing oto­ laryngologist.