Quantifying Lateral Frontal Sinus Access: The Upper Blepharoplasty Approach

Objective: Despite advances in technology and instrumentation, access to the lateral frontal sinus remains a challenge for surgeons. We sought to quantify the reach and applicability of the upper blepharoplasty approach (UBA) to the frontal sinus. Methods: Twelve cadaveric specimens were obtained for anatomic research and frontal sinuses divided into 3 zones. Zone 1 was defined as medial to the supraorbital neurovascular bundle (SON). The remaining orbit was then bisected to define zone 2 (centrally) and zone 3 (laterally). Twenty-four UBAs were performed followed by 12 modified endoscopic Lothrop procedures (MELP). The ability to instrument each wall of the frontal sinus was recorded for the MELP, UBA, and combined approach. Results: The UBA provided excellent access to the lateral frontal sinus in zones 2 and 3 (89% and 100%). The MELP provided poorer access in zone 3 (67%) but improved access in zone 1 (83%-100%). Access for zone 1 through the UBA was limited. The combined approach yielded 100% access to each frontal sinus boundary. Conclusion: The MELP in combination with the UBA/lateral trephination provides excellent access to each frontal sinus boundary. The UBA provides excellent access to the lateral frontal sinus but is limited medially by the SON.