Chirurgie du sinus frontal (tumeurs et traumatismes exclus)

Surgery of the frontal sinus is probably the most challenging procedure for the nose and sinus surgeon, not only because of the complex anatomy of the fronto-nasal duct, or the proximity of vital structures which can make the dissection very difficult, but also because of the difficulty to constantly get good functional results. The numerous surgical techniques that have been proposed illustrate these difficulties. The aim of this paper is to review the main surgical techniques which are used in the treatment of non traumatic and non tumour surgery of the frontal sinus, i.e., mainly in the treatment of frontal chronic sinusitis which is closely connected to anterior ethmoid pathology or prior surgery. Two main categories of surgical techniques have been described. The first are aimed at restoring drainage and ventilation of the frontal sinus; today they are generally performed by endonasal and endoscopic access, but there are still indications for external approaches. The second are aimed at excluding the frontal sinus; the mucosa must be completely resected, the fronto-nasal duct is obliterated, and the cavity filled with biologic or synthetic materials. A third category of surgery is the cranialization of the frontal sinus; this procedure needs a close cooperation with the neurosurgeons. Whatever the technique, the functional results are not always as satisfactory as expected by the technical performance, and each of them may induce a risk of complications. Frontal sinus surgery needs trained surgeons.