The technique of endoscopic surgery and diagnosis of frontal recess and sinus disease under local anesthesia.

Operations are performed with the patient in a semi-reclining position under local anesthesia. Usually a rigid endoscope (70 degrees) is used for treatment of the nasofrontal-duct. Intranasal procedures are conducted in close anatomical relationship to the ground lamella in the ethmoid sinus. First, the bulla is resected through the middle meatus, then IIIgl is removed and the posterior ethmoid sinus is opened. The upper part of the ethmoid sinus is removed, and then infundibular cells connected to the naso-frontal-duct are cleared and communication with the frontal sinus is enlarged using special forceps. The lateral wall at this portion curves outward superiorly and the roof curves upward anteriorly, and it is necessary that this area be made as smooth as possible. Most cases of suppurative frontal sinusitis are curable just by opening nasofrontal-duct via endonasal approach using an endoscope.