Advances in endoscopic Frontal Sinus Surgery

The challenging nature of endoscopic frontal sinus surgery, owing to the tendency for recurrent disease as well as the close proximity of critical structures, mandates a comprehensive understanding of operative strategies. The development of newer technologies such as surgical navigation and balloon instruments may instill a false confidence in the surgeon. The objectives of this update are to describe anatomical principles and surgical techniques involved with the various Draf procedures and to review the indications for frontal sinus surgery. The Draf approaches and associated variations have revolutionized the management of chronic frontal rhinosinusitis, as purely endoscopic approaches may minimize the morbidities classically accompanying open procedures.