Indication and limits in frontal sinus surgery: decision criteria

Frontal sinus surgery represents a complicated challenge in sinonasal surgery, due to its proper anatomic features with narrow spaces and its proximity to structures with high risk of complications (orbit, intracranial content, nasolacrimal pathway). Still debated remains the choice of the correct surgical approach, given the choice between an external one, an endoscopic one or a combined procedure. The present report will discuss the three main aspect in the decision-making process of the appropriate surgical approach that should be used: histology, anatomy, and extent of disease. Surgical equipment and techniques refinements empowered endoscopic transnasal surgery in the management of the frontal pathology, allowing less invasive procedures and lower incidence of comorbidities compared to external approaches.