Perspective Chapter: Frontal Sinus – Updates on Classification and Surgical Approaches

Abstract

Endoscopic approaches to the frontal sinus have grown significantly in the last decades and due to its complex anatomy, including the possibility of pneumatization in different cells and anatomical variations, possess numerous challenges to the endoscopic surgeon. Moreover, the proximity to noble structures such as the cribriform plate, orbit and anterior ethmoidal artery can increase the risk of injury. Unlike the maxillary, ethmoidal and sphenoidal sinuses, the frontal sinus is not in line of visualization with a zero-degree endoscope and often requires an angled endoscope. Several anatomical classification methods have already been proposed for frontal sinus, however, these previous systems present limitations of anatomical details. In 2016, the International Frontal Sinus Anatomy Classification (IFAC) was described by Wormald et al. The authors propose improved classification of the frontoethmoidal cell in diagrammatic nomenclature to facilitate greater accessibility in surgical planning.