Frontal Trephination: Indications, Anatomy, Techniques, and Outcomes

  • Garret W. Choby
  • Jayakar V. Nayak


Given the challenging anatomy of the frontal recess and critical neighboring structures, surgery to the frontal sinus is undertaken in a measured and calculated manner. Historically, frontal sinus surgery was exclusively approached externally. With the advent of the endoscopic era, endoscopic techniques became the work horse for addressing frontal sinus pathology. However, in select situations, there remains a role for external approaches such as trephination.

Trephination allows direct external access to the frontal sinus via a well-masked curvilinear incision in the shadow line of the brow. Entry into the sinus can range from a simple 1–2 mm entry site to permit irrigation from above, to a 2–3 cm bone plate removal for tumor or intracranial access. This chapter describes the indications, techniques, and outcomes of this procedure.


Trephination Inferomedial portion Facial/periorbital cellulitis 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Garret W. Choby
    • 1
    • 2
  • Jayakar V. Nayak
    • 1
  1. 1.Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology – Head and Neck SurgeryStanford University School of MedicineStanfordUSA
  2. 2.Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otorhinolaryngology – Head and Neck SurgeryMayo ClinicRochesterUSA

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