External Approaches to the Nose and Paranasal Sinuses

Although endoscopic endonasal techniques in sinus surgery has reduced the indications for external approaches, the sinonasal surgeon should be familiar with external approaches. Preoperative assessment including CT, MRI, endoscopic examination, and eye assessment is mandatory. Preoperative counselling including surgical complications and the expected outcome should be explained. The nasal fossa and paranasal sinuses can be approached externally by Lateral rhinotomy or Mid-facial degloving. The Frontal sinus can be approached externally by trephination, Lynch procedure, osteoplastic approach, open sky, Gullwing or butterfly approach. The maxillary sinus can be approached externally by Caldwell-Luc, Swing maxillotomy or Weber-Ferguson approach. The ethmoid sinus can be approached externally by external ethmoidectomy or transorbital ethmoidectomy. The sphenoid sinus can be approached by sublabial transseptal approach or external sphenoethmoidectomy approach.