This surgery opens up the frontal sinus, located in your forehead. This procedure is done through the nose in most instances. The passageway up to the frontal sinus is a difficult and technically challenging sinus to open up for most surgeons. I have been sent many cases over the years by other otolaryngologists who are not comfortable with performing frontal sinus surgery. I applaud these surgeons for their honesty with their patients. Less open surgeons might tell their patients that their headaches will go away after an ethmoidectomy, when in fact they have significant frontal sinus disease.
If you suffer from frontal sinus headaches, make sure that your surgeon is confident about operating in the frontal sinus if needed. Often, a clear computed tomography (CT) scan can fool even the best surgeon into thinking that there is nothing wrong in the frontal sinus, but when he or she begins the procedure, the surgeon may find that the passageway needs to be opened.
At times, a surgeon may need to get better visualization of the frontal sinus. A small incision (4 mm) is made by the eyebrow and the surgeon can place an endoscope direcdy into the frontal sinus. As well, he or she can place instruments into the frontal sinus from above or below and work within the sinus. This incision usually heals without much of a scar.
Failure to open the frontal sinus passageway if required will usually result in the continuation of frontal sinus headaches. The frontal sinuses can be an area where residual infection and disease lingers and then spreads to the other sinuses, leading to failure of medical and/or surgical therapy. Last, if the frontal sinus is not treated properly, a cyst can occur, called a frontal sinus mucocele. This cyst can form 20-25 years after the surgery. Although benign and slow growing, the mucocele eventually erodes the back wall of the sinus into the brain or the bottom wall of the sinus into the orbit (containing the eyeball), pushing the eye off center. I coauthored the first paper on the treatment of frontal sinus mucoceles with functional endoscopic sinus surgery back in 1989.
At that time, most were skeptical. Today, most mucoceles of the frontal sinus are treated with FESS.