The external approaches to the paranasal sinuses form a group of procedures that build on one another and can be combined in various ways to gain access and exposure to the anatomic regions of the paranasal sinuses, orbit, face, anterior, and middle skull base. These procedures are germane not only to surgery for acute and chronic disease of the paranasal sinuses but also to neoplasia that involve these areas and trauma. An endoscope, an operating microscope, and/or brilliant illumination with a headlight and operating loupes, all of which are really just means of improving visualization, can certainly be used with these “greater” surgical access procedures or with more minimally invasive or transnasal approaches. Instrumentation is by no means tied to access procedures, and the wise surgeon will use those instruments and those access procedures that best allow him/her to adequately visualize the relevant anatomy and abnormality in such a way as to do his/her patient the maximal good with the least amount of harm. Some of these open procedures are essentially of historical interest in the treatment of chronic rhinosinusitis but remain worthy of some attention for the treatment of complicated acute infections, neoplasia, some inflammatory orbital conditions, and trauma.