Frontal sinus surgery for refractory disease is one of the most challenging portions of endoscopic sinus surgery, due to its challenging anatomy and close proximity to brain and orbit. The Draf frontal sinusotomy procedures have been described as a stepwise approach to address frontal sinus disease with increasing complexity. In order to perform these surgeries safely, a thorough anatomic understanding is imperative to understand this complex region.

Ethmoid and sphenoid sinus surgery can be simple and straightforward at times, but also complex and challenging, due to the close proximity to brain, orbit and important neurovascular structures. Both inflammatory and neoplastic conditions are commonly found in this region. In order to perform these surgeries safely, a thorough anatomic understanding is imperative to understand this complex region.