The Sewall-Boyden technique of reconstructing the frontonasal tract

The Sewall-Boyden flap reconstruction of the surgically created frontonasal tract created during a classic Lynch frontoethmoidectomy is a procedure that philosophically is in keeping with modern concepts of sinus and mucosa preservation that are the hallmarks of successful modern endoscopic sinus surgery. Although the procedure is now mostly of historical interest, the basis of the “frontal sinus rescue” operation and basic tenets of frontal sinus surgery owe some of their intellectual development to this mucosal flap–based tract reconstruction technique. This article provides a step by step description with detailed drawings of the technique to provide a basis for study of the procedure. Although occasionally used adjunctively today for narrow indications, the Sewall-Boyden technique has been largely replaced by endoscopic transnasal surgery procedures such as the Endoscopic Lothrop and the Draf 3.