Chronic frontal sinus disease has always been a difficult problem to treat. We undertook this study to evaluate our results of frontal recess surgery, to determine the factors which affected the surgical outcome and to determine whether the post-operative findings correlated with the symptomatic improvement in the patients. Twenty-four patients with chronic sinus pathologies involving the frontal sinus were included in this study. After failure of maximal medical treatment, they were subjected to endoscopic surgery. The factors assessed included the pneumatisation of the frontal recess on CT scan, the technique of surgery, the intra-operative frontal glow, the state of the frontal recess at the end of surgery, the appearance of the recess on follow-up endoscopy and the symptomatic relief in the patients. 81.2% of well pneumatised frontal recesses had a good outcome while only 42.1% of the poorly pneumatised frontal recesses had a good outcome. 76.2% of cases with a frontal glow seen intra-operatively had a favourable surgical result while 44.4% of cases without a frontal glow intra-operatively had a favourable surgical result. Two-thirds (66.7%) of cases with mucosa-lined frontal recess did well post-operatively while only 33.3% of cases with a raw frontal recess did well following surgery. Well pneumatised frontal recesses, presence of an intra-operative frontal glow and a mucosalined frontal recess corresponded with better post-surgical outcomes. A difference in the intra-operative technique did not influence the result after surgery. Nineteen out of 24 patients (79.2%) were asymptomatic after surgery while 5 patients had residual symptoms.

The aim of this study is to emphasise the importance of preserving the anterior facial skeleton in angiofibroma surgery and to introduce a new approach by which tumors with far lateral extensions can be operated upon successfully without disruption of the anterior facial skeleton. This is a prospective study conducted at a tertiary referral academic centre. Two patients with extensive juvenile nasopharyngeal angiofibroma with far lateral extensions were recruited and they underwent surgery between July and August 2016. Both patients were not embolised prior to surgery. Complete tumor removal was achieved in both cases without any evidence of recurrence of disease. The facial contour was well maintained. They are under regular follow-up at our centre, having completed their third 3 monthly follow-up. The main outcome measures are preservation of the anterior facial skeleton and complete tumor removal. The Four-Port Bradoo Technique allows for maximum access to the angiofibroma whilst maintaining the anterior facial skeleton, thus ensuring complete removal with minimal morbidity to the patient.