Management of the Stenosing Frontal Recess

Achieving long-term, positive outcomes from frontal surgery can be challenging. Local complications such as scarring, middle turbinate lateralization, and stenosis of surgically enlarged ostia can lead to recurrent sinonasal obstruction and eventual surgical failure. Residual inflammation can also impede mucosal recovery and incite polypoid disease, further compromising surgical results. The frontal sinus is particularly vulnerable to surgical failure given its narrow outflow and difficult accessibility to topical therapies. Patency rates after frontal sinusotomy (Draf IIA) can range anywhere from 67.6% to 92% and may diminish over time, highlighting the need for diligent surveillance following surgery and optimization of the wound healing environment during the postoperative period. This chapter will address management of the stenosing frontal recess. A broad spectrum of therapeutic options have been developed to manage this condition including postoperative debridement, balloon sinus dilation (BSD), frontal stents, bioabsorbable implants, and in-office revision frontal sinusotomy, all of which will be discussed in this chapter.