Looking around the corner: a review of the past 100 years of frontal sinusitis treatment.

Abstract

Over the past 100 years, developments in imaging studies, endoscopic evaluation, medical treatment, and surgical techniques, particularly those employing endoscopic approaches, have led to improvements in our ability to treat frontal sinusitis. Providing "around the corner" views of the frontal recess, 30 degrees and 45 degrees endoscopes have allowed the meticulous preservation of the mucoperiosteum and restoration of normal sinus physiology, even in difficult areas of the frontal sinus outflow tract. Rarely is it necessary to perform radical or obliterative frontal sinus procedures, although the osteoplastic flap obliteration approach advocated by Montgomery continues to be the gold standard for treatment of frontal sinusitis, which has failed medical treatment and endoscopic approaches, at least in the minds of many prominent surgeons. The endoscopic modification of Lothrop's approach has gained favor in the experience of many, however, despite its technical difficulty and failure rate of up to 20%. Technical advances, such as computer-assisted endoscopic surgery and, more recently, intraoperative imaging have shown promise and may lead to further improvement in treatment outcomes. Finally, we will all benefit from further advances in outcomes assessment, which will provide better scientific proof of our clinical observations.