Despite of the effectiveness of PAP in OSA treatment, significant percentage of patients are unable to adhere to this treatment long-term. Surgery is a treatment option for patients with OSA who unable to tolerate or have failed less invasive treatment options. Proper patient selection is essential to surgical success. Individual anatomic and non-anatomic factors should be taken into consideration when deciding on surgical procedures.

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.

Rhinoscopy / endoscopy is a critical component of the overall head and neck exam. This procedure is particularly important in any patients with nasal complaints or headaches. A variety of inflammatory, vascular, and neoplastic conditions affecting the nose and paranasal sinuses can only be diagnosed at early stages in this manner. The extent of disease as determined endoscopically, and further defined radiologically, will help in the planning of a definitive treatment.

Nasal obstruction is a common nasal complaint that may result from singular unilateral or bilateral anatomic perturbations. However, patients are commonly identified as having two or more factors working in concert to collectively impede nasal function. These may include combinations of septal deviation, fixed and dynamic obstruction of the internal and external nasal valves, and the effects of hypertrophied inferior turbinates.

External approaches to the paranasal sinuses have largely been replaced by less invasive endoscopic alternatives in today’s rhinologic practices. However, these approaches each maintain unique advantages in exposure and application over endoscopic approaches. There remain clinical conditions, including extensive frontal disease, bony tumors, trauma and other conditions in which the anatomical access requires more traditional external approaches. The concepts and techniques of these approaches remain paramount components of the competent rhinologist’s skillset.